Vascular access management of hemodialysis patients at the bedside using point-of-care ultrasound.

Abstract

When vascular access (VA) for hemodialysis is established using an autologous fistula or synthetic graft, repeated damage from needle insertion at each dialysis session can lead to thrombosis, resulting in vascular stenosis or occlusion that can cause poor blood removal, elevated venous pressure, and other impairments of blood flow. Compact, high-performance ultrasound devices have been developed in recent years. Such devices are used for point-of-care ultrasound (POCUS), which has been used on many occasions for emergency evaluation in the dialysis room and is becoming an important tool in VA management. POCUS provides a wealth of imaging information, such as needle position, whether the needle is inside or outside the blood vessel, and lesion position, width, and depth. This allows clinicians to detect VA problems early and take suitable measures, such as changing the cannulation site, thereby avoiding the need for unnecessary and highly invasive angiography or surgical procedures.