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Forty years of vascular access.

Article Excerpt
The American Nephrology Nurses' Association (ANNA) is celebrating its 40th anniversary (19692009), and what better way to celebrate than to look back to see how vascular access started and how it has evolved over this time span. To some, it will be a history lesson; to others, it's what we "grew up" with. What everyone will notice is that all vascular access is a variation on a common theme: trying to find that perfect access for all patients on hemodialysis.

Over 40 years ago, machines to cleanse the kidneys were evolving, but an equally important aspect of dialysis--developing a long-term vascular access--was still in its infancy. March 9, 1960, was the start of what we know today as maintenance or chronic hemodialysis. This was the day that Clyde Shields became the first patient to receive what was to become the first "permanent" arteriovenous vascular access--the Scribner shunt (Konner, 2005). The Scribner shunt consisted of two rigid Teflon tubes in which one end was inserted into an artery and the other end was inserted into a vein, and Silastic tubing was connected externally and allowed for continuous blood flow (see Figures 1 and 2). For the first time, physicians and dialysis nurses were able to access both the arterial and venous sides of the circulatory system through the same access.

Over the course of the next 9 years, the dialysis community saw variations on the Scribner shunt, including the Ramirez shunt, which was a straight cannula that allowed for easier clot removal. Unfortunately, shunts only had a life expectancy of approximately 7 to 10 months (Drukker, 1989). Needing to find an access that would survive longer than 10 months became the challenge. The most important vascular access development of all time occurred in 1966, when Appel, Brescia, and Cimino decided to connect an artery and a vein together, which created the first arteriovenous fistula (AVF). Three years later in 1969, the first of several modified AVFs were being used for vascular...

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