▨ use when CrCl /GFR <25 ml/min ▨ use when Scr >4 mg/dL

▨ natural ▨ longest survival ▨ lowest rate infxn ▨ lowest rate hospital ▨ most cost effective ▨ most easiest to make

▨ takes 1-2 months ▨ difficult in elderly ▨ difficult in pvd pts

▨ takes 2-3 weeks

▨ synthetic ▨ shorter survival than fistula ▨ higher rate of infxn / thrombosis

▨ can be used immedia. ▨ lesser pain ▨ used in small children ▨ used in DM pts w/ VD ▨ used in pts w/ no AV access sites

▨ shortest lifespan ▨ highest rate of infxn ▨ highest rate of thromb. ▨ may have poor flow rates

femoral vein

subclavian vein

internal jugular vein

▨ 4hrs [3x/week] ▨ 4hrs [7x/week] critical pts ▨ uses diffusion & ultrafilteration

▨ rapid removal of volume/solutes ▨ correctxn of electros.

▨ hypotension due to large fluid shifts from intraV space

▨ goes on 24hrs/day ▨ uses either diffusion, ultrafilteration, or both ▨ most preferred access for this = catheter

useful in pts w/ major diseases

▨ ↑d incidence of extracorporeal thrombosis req'ing add'l anticoagulaxn ▨ req's special equipt. ▨ higher costs ▨ labor intensive

· fluid · midodrine · decrease filteration rate

setting dry weight

fluid

· vitamin E · quinine

1) saline flush 2) alteplase 2mg 3) attempt aspiration after 30mins 4) may repeat in 2hrs if still low flow

Ø w/ antiplatelets Ø w/ anticoagulants

Treatment

Treatment

Treatment