Right Access, Right Time: How Nurses Can Advocate for Best Practice

Hemodialysis requires vascular access by way of an arteriovenous fistula (AVF), arteriovenous graft (AVG), or intravenous hemodialysis catheter. There is overwhelming evidence that an AVF should be the access of choice due to its lowest infection rate compared to an AVG or hemodialysis catheter; however, less than 17% of patients on hemodialysis have a functional AVF when hemodialysis treatment is initiated. Most patients with end stage kidney disease begin hemodialysis using a hemodialysis catheter, which has a higher infection rate. Nephrology nurses can advocate for best evidence-based practice, understanding that AVFs have lower infection and lower thrombosis rates, and provide more effective hemodialysis. This article provides a literature review for types and indications of hemodialysis access and how nurses can promote this best practice.