Dialysis Access

Dialysis Access

What is it?

When a patient's kidney fails, the body cannot remove impurities or regulate fluids and chemicals in the blood. Dialysis is like an artificial kidney, performing the work the kidney used to do. But to optimize dialysis, access to your bloodstream needs to be created to allow continuous and high volumes of blood to circulate through the dialysis machine.

There are three main types of dialysis access used. A fistula, the most preferred treatment, connects an artery to a vein to increase blood flow into the vein and strengthens it to make access for treatments easier.  A venous catheter is used as a temporary access, where a catheter is inserted into a vein in the neck, chest or near the groin. A graft is an artificial tube made of plastic that connects an artery to a vein, after which the graft acts as a vein that can be used for access. Less commonly, a vein from your leg may be used for a graft. Fistulas and grafts are placed under the skin, usually in the arm.

In order to determine which access is the best for you, an ultrasound of both arms is performed to show the size of the veins. If the veins are blocked or are too small, a graft is usually recommended. Hand dominance, previous surgeries, artery disease and the presence of a pacemaker also influence which type of access is recommended.

These access procedures can be performed as an outpatient, take about two hours, and can be performed under local anesthesia. They are performed several weeks prior to starting dialysis in order for the fistula or graft to function properly. If dialysis is needed to be performed urgently, the placement of a catheter in the neck, groin or abdomen may be necessary.

What are the risks?

Complications of these procedures include blockages, bleeding and infection (more common in grafts). Although rare, reduced blood flow to one hand, also called “steal,” can occur causing the hand to become painful, cool and numb.  Complications may be treated surgically.

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