**7. Conclusion**

Percutaneous nephrostomy is a widely used urological procedure, providing urinary diversion and access to the urinary tracts for other interventions. While demonstrating a good safety profile, many aspects of the procedure are associated with risks of complications, which may be contributed by various factors from the moment the patient is prepared until after the procedure. The performing physician must not only be well versed with the techniques involved, but he or she should also be well acquainted with the associated risks and complications so that these may be detected and treated early.

#### **8. References**


**19**

*Colombia* 

Cesar A. Restrepo V

**Unusual Vascular Access**

**for Hemodialysis Therapies** 

*Division of Nephrology, Department of Health Sciences, Caldas University, Manizales,* 

For many years, the arteriovenous (AV) fistula has been demonstrated to be the best

The morbidity and mortality statistics for patients with AV fistula is significantly lower compared to patients with central venous catheters (1). However, many patients are found in which performing an arteriovenous fistula or implanting an AV graft is not a possibility. For these patients the usual protocol is the use of an indwelling catheter for chronic

The appearance of patients incompatible with AV fistula is due to the repetitive venous punctures in classical blood vessels, performed in the intensive care unit or for patients with chronic renal failure. These patients develop venous fibrosis making subsequent

The use of central venous catheters for initial hemodialysis therapy is also a common practice, this situation is repeated in all countries so that in the United States 60% of incident patients and 17 to 30% of prevalent patients depend on it as the only vascular access catheter despite the recommendation of the K/DOQI guides (Kidney Disease Outcomes Quality

In the year 2010, 100% of incident hemodialysis patients in our renal unit were treated with a central venous catheter. This reflects a late referral of doctors to the nephrology clinic,

In the same year 259 central venous catheters were implanted in our Renal Unit, 34% of them were transient in acute renal failure patients, 56% transient in patients with chronic renal failure and 10% tunneled catheters. Additionally our statistics showed that at the end of the year 2010 tunneled catheters represented 25% of vascular accesses and that in 94% of the patients using these catheters, arteriovenous fistula or AV graft implant were impossible, thus constituting the catheter tunneled the only access for the practice of

Traditionally, the most used vascular access is the internal jugular venous, but it can fail due to permanent thrombosis or agenesis. In these situations the usage of even more unusual

vascular access for patients requiring chronical hemodialysis therapy.

**1. Introduction** 

hemodialysis therapy practice.

preventing the early practice of AV fistula.

cannulations impossible.

chronical hemodialysis.

Initiative). (2)

