Elección de acceso vascular en un paciente tetrapléjico en hemodiálisis: un obstáculo a superar

Vascular accesses are one of the mainstays of hemodialysis. The ideal access should provide an adequate blood flow, be long-lasting, allow easy and uncomplicated handling. The choice of access should be individualized for each patient, according to various aspects such as clinical history, vascular map or patient preferences. Autologous arteriovenous fistula is the access that most resembles the qualities of ideal access, being the first-line access. Tunneled central venous catheters are restricted for situations with inability to achieve first-line access. The aim of this article is to show the experience of a tetraplegic patient in HD, in the search and selection of his vascular access. The choice of the most appropriate access in such cases has important added connotations, so the decision is not always easy. On the one hand, the first-line access may limit or condition the daily work of tetraplegic / paraplegic patients, and, on the other hand, catheters substantially increase the risk of infections and morbimortality.