Dialysis Access

What is it?

In hemodialysis, a machine removes a portion of your blood to eliminate impurities and regulate chemical balances and then returns the purified blood to you. This is done through an entrance called a dialysis access created beneath your skin, usually in your arm or leg. The two main types of dialysis access, an arteriovenous fistula (AV fistula) or an arteriovenous graft (AV graft).

What is it for?

During hemodialysis, needles are placed into the access and carry blood to and from the dialyzer machine.

How to prepare

In an arteriovenous fistula, an ultrasound is performed to evaluate blood vessels a surgeon can use. The ultrasound will reveal how quickly blood flows between arteries and veins

Risks

• Clotting
• Infection
• Reduced blood flow

What happens during?

Both are short, surgical procedures done under anesthesia in a hospital or outpatient center.

• An AV fistula connects an artery to a vein. The large vein (fistula) allows for rapid and high blood flow and is thick enough for needles to be inserted safely several times each week during dialysis. It can several weeks or even months for the fistula or the graft to grow and develop before they are ready to use.
• If dialysis is needed immediately, a temporary venous catheter may be used in an AV graft, a piece of synthetic tube is sewn between an artery and vein. Blood can move through the graft from the artery to the vein.

What happens after?

You may be able to go home the same day of your procedure. You will need to:

• Keep the access clean at all times
• Not wear jewelry or tight clothes over the access site
• Protect the access and keep it free from cuts or bumps
• Check daily for the vibration that the access produces
• Watch for redness, tenderness, infection or pus near the access
• Not allow a blood pressure cuff on the access arm
• Avoid sleeping with the access arm under the body or head
• Refrain from lifting heavy objects or putting pressure on the access arm

More information:

• National Institute of Diabetes and Digestive Kidney Diseases