Globally, more than 2 million people are receiving dialysis treatment or awaiting a kidney transplant. For these dialysis patients, treatment falls into three kinds of access: fistula, grafts and catheters (central venous catheter).
Why some physicians are saying "Catheter Last"
The "Fistula First Initiative" remains the gold standard of care around the world. However, this recommendation is not suitable for all patients; operators turn to central venous catheters (CVCs) second and synthetic grafts last. Publications have shown an increase in severe complications associated with CVCs, resulting in a paradigm shift to "Fistula First, Catheter Last." Grafts capable of early cannulation are a viable option for avoiding catheter-related complications.
An early cannulation option that is not a central venous catheter (CVC)
Sometimes fistula is not an option. Skilled operators need a prosthesis designed to withstand repeated needle cannulation, without the complications traditionally associated with conventional ePTFE grafts. Traditional ePTFE graft sweating, pseudoaneurysm, and two to four week maturation times on cannulation are the reason why many operators turn to CVC catheters. Unlike traditional grafts, publications demonstrate that Flixene can be cannulated in 24-72 hours while maintaining comparable patency rates to ePTFE grafts which were given 2-4 weeks for maturation. Combined with Getinge’s proprietary Graft Deployment System (GDS), Flixene is changing patient care around the globe.
Optimal techniques for arteriovenous access cannulation
Proper site maintenance and access procedures are essential to maintaining patency and giving our patients the level of service they need. Are you practicing the correct techniques for determining the access site, preparation, needle placement and blood flow? What are the signs that your patient is doing well or needs help?
Published data on an ePTFE graft that allows upper arm cannulation in days, not weeks
The study compares the clinical outcomes of 108 patients who have received one of the following three upper arm access types; transposed brachiobasilic arteriovenous fistula (BBAVF), autogenous brachial vein-brachial artery access (ABBA), and Flixene ePTFE vascular graft (AVG). While BBAVF remains the ideal standard of care for most patients, authors noted comparable overall results for AVG patients and improved outcomes for select patients who received AVGs.