Hemodialysis access procedures
Kidney failure - chronic - dialysis access; Renal failure - chronic - dialysis access; Chronic renal insufficiency - dialysis access; Chronic kidney failure - dialysis access; Chronic renal failure - dialysis access
Vascular access (often called just "access") is needed for you to get hemodialysis. The access is where you receive hemodialysis. Using the access, blood is removed from your body, cleaned by the dialysis machine (called the dialyzer), and then returned to your body.
Usually the access is put in your arm but it can also go in your leg. It takes a few weeks to a few months to get an access ready for hemodialysis.
Description
A surgeon will put the access in. There are three types of accesses.
Fistula:
- The surgeon joins an artery and vein under the skin. That is why this is called an arterio-venous or A-V fistula.
- With the artery and vein connected, more blood flows into the vein. This makes the vein strong. Needle insertions into this strong vein are easier for hemodialysis.
- A fistula takes 1 to 4 weeks to become ready to use.
Graft:
- If you have small veins that cannot develop into a fistula, the surgeon connects an artery and vein with an artificial tube called a graft.
- Needle insertions can be done into the graft for hemodialysis.
- A graft takes 3 to 6 weeks to heal.
Central venous catheter:
- If you need hemodialysis right away and you do not have time to wait for a fistula or graft to become ready for use, the surgeon can put in a hemodialysis catheter.
- The catheter is put into a vein in the neck, chest, or upper leg.
- This catheter is temporary. It can be used for dialysis while you wait for a fistula or graft to heal.
Why the Procedure Is Performed
Kidneys act like filters to remove extra fluid and waste from your blood. When your kidneys stop working, hemodialysis can be used to clean your blood. Hemodialysis is usually done 3 times a week and takes about 3 to 4 hours.
Your kidneys are in charge of filtering wastes out of your blood. But, if your kidneys don't work as well as they should, you may need a procedure called dialysis, a process that removes wastes in place of your kidneys. Let's talk about dialysis. Your kidneys have several important jobs. In addition to filtering your blood, they help maintain just the right balance of water, acids, and minerals in your body. They also function as part of the endocrine system producing hormones. If you've had kidney disease for many years, or your kidneys have suddenly failed because of disease or injury, your doctor may recommend that you have dialysis, a treatment that replaces some of what the kidneys do, removing waste and excess fluid from your blood. It is sometimes used as a holding treatment while awaiting a kidney transplant. Here's how dialysis works. First, your doctor will need to create an access to reach your blood vessels. If you need dialysis only for a short period of time, that access will be made using a hollow tube, called a catheter. Usually the catheter is placed into a large vein in your neck, chest, or leg near your groin. If you're having dialysis for a longer period of time, you'll need a more permanent access. To create this access, your doctor will connect one of your arteries to one of your veins. Then whenever you have dialysis, a needle is simply placed into this access area. During each dialysis session, your blood is removed from your body through the needle. It's sent across a special filter, which removes harmful substances from your blood. Then, your clean blood is sent back into your body. Often, you'll visit a special center for dialysis about three times a week. Each session lasts three to four hours. Or, you may be able to do dialysis right at home three times a week or even daily. Home sessions are shorter, about 2 to 3 hours, and they're easier for your body to tolerate. Before you perform dialysis at home, a nurse will teach you how to place the needle, how to clean the machine, and monitor your blood pressure during treatment. It's important when you're having dialysis that you do all of your scheduled sessions. Also, call your doctor right away if you have any problems, like swelling, redness, fever, a drop in blood pressure, or bleeding. These could be signs that you've developed an infection or other complication from your dialysis, and need medical attention.
Risks
With any type of access, you will have a risk of developing an infection or a blood clot. If infection or blood clots develop, you will need treatment or more surgery to fix it.
Before the Procedure
The surgeon decides the best place to put your vascular access. A good access needs good blood flow. Doppler ultrasound or venography tests may be done to check blood flow at a possible access site.
Vascular access is often done as a day procedure. You can go home afterwards. Ask your surgeon if you will need someone to drive you home.
Talk to your surgeon and anesthesiologist about anesthesia for the access procedure. There are two choices:
- You can receive medicine that makes you a little sleepy and local anesthetic to numb the site. Cloths are tented over the area so you do not have to watch the procedure.
- You can receive general anesthesia so you are asleep during the procedure.
After the Procedure
Here is what to expect:
- You will have some pain and swelling at the access right after surgery. Prop your arm up on pillows and keep your elbow straight to decrease swelling.
- Keep the incision dry. If you have a temporary catheter put in, do not get it wet. An A-V fistula or graft can get wet 24 to 48 hours after it is put in.
- Do not lift anything over 15 pounds (7 kilograms).
- Do not do anything strenuous with the limb with the access.
Contact your surgeon if you have any signs of infection:
- Pain, redness, or swelling
- Drainage or pus
- Fever over 101°F (38.3°C)
Outlook (Prognosis)
Taking care of your access will help you keep it as long as possible.
A fistula:
- Lasts for many years
- Has good blood flow
- Has less risk for infection or clotting
Your artery and vein heal after each needle stick for hemodialysis.
A graft does not last as long as a fistula. It can last 1 to 3 years with proper care. Holes from the needle insertions develop in the graft. A graft has more risk for infection or clotting than a fistula.
References
National Institute of Diabetes and Digestive and Kidney Diseases website. Hemodialysis.
Yeun JY, Young B, Depner TA, Chin AA. Hemodialysis. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 63.
Version Info
Last reviewed on: 8/28/2023
Reviewed by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
