Placement of permanent vascular access devices: surgical considerations.

The maintenance of adequate vascular access for hemodialysis is a challenge for all involved in the care of the patient on hemodialysis. Careful planning, early placement, a stepwise approach to vascular access, and careful observation for complications are necessary to assure the availability of long-term access. Above all, a coordinated approach involving the nephrologist, dialysis unit personnel, surgeon and radiologist is the best way to provide optimal, efficient care to the hemodialysis patient.