Ideal vascular access should provide safe and effective therapy by enabling the removal and return of blood via an extracorporeal circuit. It should be easy to use, reliable and have minimal risk to the individual receiving haemodialysis. However, the provision of good quality access remains difficult to achieve. Native access requires prior planning and has a high primary failure rate. Arteriovenous grafts utilising replacement of synthetic or biological material in conjunction with native vessels again require planning and surgical expertise. Venous catheters are in common usage (and in a smaller number of patients remain the only form of access that is available), but offer inferior therapy.
This guideline updates the section on vascular access in the haemodialysis module of the 5th edition of the RA guidelines published online in 2011. It is recommended that cross-reference is made to the 6th edition of 'Planning, Initiating and Withdrawal of Renal Replacement Therapy' published by the RA in 2013.