Dialysis Access Care is the vascular creation and care of your vascular access for dialysis. It makes life-saving dialysis possible. A vascular surgeon surgically creates an arteriovenous fistula to allow the body to remove and return blood during dialysis. It allows a large amount of blood to flow continuously during dialysis to filter as much blood as possible per treatment. The access should be created in the arm months in advance of dialysis treatments, so that it can mature. Allowing the vascular access to mature helps reduce the risk of narrowed veins, low blood flow, infection and blood clots.
There are 2 types of vascular access:
1- The Arteriovenous (AV) Fistula: The AV Fistula is created by a vascular surgeon during a surgical procedure to connect a vein to an artery, commonly in the arm. The pressure in the artery and the flow of blood create the fistula in the vein. The process where the vein enlarges and the vein walls thicken is called maturation. The AV Fistula access takes 3-6 months to mature. Until then it cannot be used. Despite the time it takes to mature, the fistula is the most reliable vascular access, has the longest life and least amount of problems.
The AV Fistula is the preferred vascular access because it has the lowest rate of infection, and clot formation. However, older patients and patients with small veins may not be good candidates for this procedure.
In preparation for an AV Fistula, your vascular surgeon may map and evaluate your blood vessels using ultrasound. This tells the surgeon how much and how fast the blood flows, which allows the surgeon to select the best vessels for this procedure. The surgery is performed in an outpatient setting with local anesthetic and sedation, or general anesthesia.
2- The Venous Catheter: A venous catheter is a surgical procedure where a catheter (a thin tube) is placed in a large vein in the body, commonly in the neck, chest or groin. The external part of the catheter has tubes that connect to the dialysis machine. This has a higher risk of infection, blood clots and clogging of the tubing which do not exist with an AV Fistula.
It is created only for short-term dialysis treatment for patients new to dialysis, who need urgent dialysis, and do not have the time required for an AV Fistula to mature. The venous catheter is an outpatient procedure using local anesthetic and sedation. While not an ideal access, it works for a few weeks to months until the surgeon can create an AV Fistula.
The most common problems are low blood flow caused by clotting and infection. AV Fistulas have the lowest risk for these problems, while vascular catheters have the highest risk. Both types of vascular access can cause problems and may require further treatment or surgery.
Should an infection occur with your venous catheter, antibiotic therapy will help. If clotting is an issue, blood thinners will help prevent clotting. When medications fail to treat these problems, the catheter will require replacement.
An AV Fistula that has been in place for a long time can develop flow problems. Procedures are available for treatments of fistula problems. The AV Fistula can also develop a stenosis or narrowed area, which decreases the efficiency of dialysis. It can be treated with angioplasty. When blood clots develop, a new vascular access may be needed.
Because this is your lifeline to dialysis, you, the patient, must take good care of your vascular access.
Ask your kidney specialist to schedule an appointment with an expert vascular surgeon for vascular access. The board certified vascular surgeons at South Valley Vascular specialize in vascular access for dialysis and chemotherapy. We have three locations in Visalia, Porterville and Hanford, California to provide convenience for our patients. We look forward to providing you with the best care for your needs.
Need more information on Dialysis Access? Visit the Society for Vascular Surgery’s Patient Resources section here.