perm cath vs AVGs

[dodoy, BSN, RN]

So I've been working on a hemodialysis unit for a year now, and quite recently I have seen cases of access failures (usually AVFs failing to mature fully, I've seen two patients both diabetic), and after their check up with a vascular surgeon, they were advised to have a permanent catheter instead of a graft (AVG). One particular reason of the surgeon that was told to the patients was that their blood vessels are not that suitable for placement of a graft. Usually I hear vasc. surgeons saying that a DM patient's blood vessels are fragile and usually small. So my big question is, what are some of the indications of having a perm cath rather than a graft? Responses are really appreciated! Thanks

[wordsmith]

From what I've seen, the docs consider the CVCs semipermanent or permanent when there have been multiple failures of the AVF or AVG. The failures are usually clotting that doesn't respond to drug therapy like Plavix (AVGs or AVFs), or AVFs that do not mature or that grow so much collateral circulation that they can't be properly cannulated (not common). Our surgeons will keep trying--I've seen them do half-a-dozen surgeries on some people to get the access working, but it really depends on the patient. Some, as you said, have small vessels, but it's not always the diabetics; some were smokers, and some it's just genetics.

Hope this helped.