Complications of vascular access in patients- undergoing haemodialysis at the Kenyatta National Hospital

Abstract

Between July, 1990 and February, 1991, a total of thirty seven (37) patients on intermittent. haemodialysis were studied for vascular access complications and difficulties. Twenty-three (62.0%) wet e males and Ioui teeu (38%) were fenHtleb. Their ages ranged between 10-62 years with a mean age of 32.2 ± 6.8 (2 SD). Sixteen (41%) patients had subclavian vein catheter (SVC), five (13%) had arteriovenous shunts (AVS) and eighteen (46%) had arteriovenous fistulae (AVF). The mean survival time of a vascular access is the duration or survival of a particular vascular access in months [or weeks). It was deter mined by the number of patients-months of dialysis divided by the number of vascular access insertions or creations. The mean arterial (or venous) caunular survival time fur AVS was 3 months, for SVC was 3 months and for AVF was 9 months. Thirty two (60%) of the patients on haemodialysis had vai ious complications related to the vascular accesses. Eight (50%) of the SVC were infected. One (2070) of the AVS was infected. Not. a single case of infected A\T was encounteredo Out of the nine infected vascular accesses, staphlococcus aureus was grown in five (55%). Four (25%) patients with SVC had thrombus formation in the catheters. Two (40%) patients with AVS had thrombus formation in the tubing. One (5.5%) patient. with AVF had a clot. Iounation in the needle used Ior needling the AVF. Two (12.5%) patients, who haJ previous SVC developed subclavian vein thrombosis which resulted into massive swelling of the whole upper limb. This is a rare vascular access complication when compared with other vascular access complications. One (20%) patient with AVS and another one (5.5%) with AVF had bleeding episode from the vascular access. No bleeding episode was encountered in SVc. Two (12.5%) patients had SVC inserted into the internal jugular vein instead of the superior vena cava. One patient developed a haematoma aftel AVF creation. One patient (5.5%) with AVF developed radial "artery steal" syndrome. Three (16.7%) patients with AVF created in the antecubital fossa had difficult needling during haemodialysis. Five (27.8%) patients had AVF created which failed to function within 2-4 hours of creation. The catheters came out from two (12.5%) patients with SVC because of loose anchoring stitch. From this study, it is suggested that check x-rays after SVC insertion should be mandatory. SVC and AVS should not be used for more than 3 months because chances of complications increases drastically after 3 months. Coagulation screening should be carried on all patients scheduled for AVF creation. Patients should be well hydrated before AVF creation to avoid hypotension a major reason for failed AVF. Patients Blood Pressure should be well controlled before AVF creation to avoid hypotension which also leads to AVF failure to function. Anchoring stitches should be firmly stitched and if they come out, they should be re-stitched immediately. Vascular surgeons should be advised to avoid creating AVF in the antecubital fossa because of the difficult in needling of these fistulae. In addition: the vascular surgeons should make sure that the created AVF are subcutaneous for easy needling during haemodialysis.