During a time span of 4½ years, 43 patients have been treated by extracorporeal hemodialysis. Approximately 1,500 dialyses are accomplished each year, mostly on patients with end-stage renal disease. During this time, we have used two major modes of vascular access. During the first 2½ years, the Quinton-Scribner shunt was used almost exclusively.1 All of the patients currently on maintenance dialysis have had buried-subcutaneous fistulas established. About half of 16 patients have two buried fistulas, one in each upper extremity. With this arrangement, we can alternate arms; or if there is difficulty in placing two needles in one arm, the contralateral extremity can be used for access.
Nurses are instructed to place the cannulae as far apart as possible and alternate needle sites to allow healing before a previous site is used for puncture. They are also instructed to perforate the vein at approximately 1 to 1.5 cm distant