Hemodialysis Vascular Access Placement

Overview

If your kidney isn’t functioning well, you may need dialysis, a way of filtering impurities from your blood. The placement of a dialysis catheter will allow an access point for hemodialysis.

What to Expect from Vascular Access Placement

If it has been determined that you need kidney dialysis, vascular access placement is an important part of your care. The vascular access provides an entrance and exit point, for the blood during hemodialysis treatment. If you have chronic kidney disease and the need for dialysis is anticipated, vascular access will be placed several weeks or months before you begin dialysis so that you have time to heal. It is usually placed in your non-dominant arm — so if you are right-handed, it would be placed into your left arm.

There are several types of vascular access procedures for hemodialysis:

Arteriovenous (AV) fistula

This type of hemodialysis assess consists of a connection between an artery and a vein in your arm or wrist. An AV fistula provides the needed blood flow, lasts for years and is less likely than other types of access to become infected or form clots. As a result, it is considered the gold standard of hemodialysis access. An AV fistula takes several weeks or months to develop after placement.

Arteriovenous (AV) graft

If you are unable to develop a fistula, an AV graft may be needed. This might be the case if you have small veins. An AV graft uses a synthetic tube implanted under your skin to connect an artery with a vein. The graft serves as an artificial vein. This graft typically can be used within two – three weeks after placement. AV grafts are more prone to infections than AV fistulas, however if you keep the graft dry and clean, it can last for years.

Venous catheter

This type of access involves placement of a catheter with two chambers — allowing for two-way blood flow — into your neck or leg. To hold the catheter in place, a cuff may be placed under your skin. Catheters do not allow blood to flow as rapidly as other types of access do, and they have a higher chance of becoming infected. However, if you need dialysis started right away, a catheter will be used. It is usually considered a temporary solution.

Peritoneal dialysis

It might be noted, or made more obvious that this is different from hemodialysis. This type of dialysis uses your abdominal lining as a filter instead of a machine outside your body. A catheter is placed in your abdomen which allows dialysis fluid to flow into and out of your body.

Questions to Ask Your Doctor About Hemodialysis Vascular Access Placement

• What type of vascular access will I be getting?
• How long will healing take place?
• If I receive a hemodialysis catheter, how long until I receive and use a more permanent form of vascular access?
• How is a hemodialysis catheter removed?
• Will there be much pain during and after healing?
• How often will I need dialysis? Are there any activities I need to avoid while the hemodialysis vascular access is in place?