Dialysis Access
What is Hemodialysis Access?
Hemodialysis is the most common type of dialysis. Patients who undergo hemodialysis go to a dialysis facility several times a week where a machine draws blood through tubes and cleans the blood of toxins before returning it to the body.
Before undergoing hemodialysis, however, your vascular physician will create an arteriovenous fistula or graft in your arm or leg so that technicians or nurses at a facility can access it for proper dialysis. The fistula or graft is created by connecting a vein or graft to an artery. The prominent, high-flow conduit which results from the surgery are readily punctured by large needles used for removing blood from the body, then returning it after it passes through the hemodialysis machine. Such fistulas require repetitive ultrasound surveillance and, intermittently, intervention by balloon dilatation or stent placement for narrowed areas in these veins.
What is Peritoneal Dialysis?
Rather than blood leaving your body to be cleaned by a machine, peritoneal dialysis uses the lining of your abdomen, called the peritoneal membrane, and a special sterile solution to clean your blood.
First, a vascular surgeon performs a minimally invasive procedure inserting a catheter into your peritoneum through your abdomen. Once this is in place and secured, A sterile fluid can be instilled through the catheter into your peritoneum to clean the blood inside your body. You or your caregiver can perform this type of dialysis at home.
However, not everyone is a good candidate for PD. You likely will not be able to receive PD if you:
- Have an abdominal hernia
- Have inflammatory bowel disease
- Have recurring diverticulitis
- Have large surgical scars on your abdomen
There are also advantages and disadvantages to peritoneal dialysis. Some advantages include outpatient procedure for creation of catheter, needles are not used for dialysis, you can perform this type of dialysis at home. Some disadvantages are that you will not be able to take a bath or go swimming for as long as you have a peritoneal catheter, and the risk of infection is higher with a peritoneal catheter compared to an arteriovenous fistula for hemodialysis. Consult with your nephrologist and vascular surgeon to determine if peritoneal dialysis is right for you.
Dialysis therapy helps to clean and filter your blood when your kidneys fail. Dialysis access can be established in four ways:
1) Tunneled Catheter
A catheter is used to access one of your big veins in your neck. It’s temporary and is used until semi-permanent access like an AV fistula/graft or a peritoneal dialysis catheter can be established. The risk of infection is high when you have the catheter for a long time, it also increases your risk for a blood clot in the vein.
2) Arterio-venous Fistula
A connection is made between an artery and a vein, in your hand or leg, enabling the sewn-in vein to enlarge and grow thicker. It is considered the best option as it has the lowest risk of infection. It usually will take up to 2-3 months before it’s ready for use for dialysis.
3) Arterio-venous Graft
A connection is made between an artery and vein using a prosthetic graft (U shaped plastic tube). This is a preferred option if your veins are too small for creating a fistula. The risk of infection is higher as this not made of a natural tissue. It will take at least 4 weeks after surgery for the graft to be ready for use for dialysis.
4) Peritoneal Dialysis
A small tube called a cannula is placed in your abdomen. The lining of your abdomen called the peritoneum is used to filter the blood. You introduce and remove fluid through the cannula/small tube several times a day. It can be done at home but there is a risk for infection and the tube can get clogged.
Still have questions? If you need more information, don't hesitate to contact us!
Our vascular surgeons, at Seattle Vascular Surgery, are experts in
dialysis access creation and maintenance. As no access will last forever, we understand the
complexities and nuances of regular monitoring and surveillance. We are committed to
partnering with and providing excellent care to our patients and their healthcare team.