At the VCU Health at Baird Vascular Institute, our experts are uniquely equipped to deal with the maintenance and care of your dialysis access in a convenient, neighborhood setting. With the latest technology and highly skilled staff, each case is approached as a unique and individual patient, complete with plans of care and follow-up.
If you are starting hemodialysis treatments in the next several months, one crucial step before starting regular hemodialysis sessions is preparing a site on the body to access the vein. Dialysis access is the site on your body where blood is removed and returned during dialysis. To maximize the amount of blood cleansed during hemodialysis treatments, dialysis access should allow continuous high volumes of blood flow.
There are three access options for the dialysis patient – AV fistula, AV graft or a central venous catheter.
To allow for the high volume of blood exchanged, dialysis access to your blood is usually in your arm or leg. Choosing your access is a decision that you and your doctor will make.
Here is some additional information about your options.
An AV (arteriovenous) fistula is a surgical connection of one of your own arteries to a vein under the skin of your arm. It’s the most natural dialysis access because it’s made with your own blood vessels. Most people can tolerate an AV fistula. However, if your veins are too small or too weak for a fistula, there are other options.
An AV fistula requires advance planning because the fistula takes a while to develop, or mature, after surgery, — in rare cases, as long as 24 months. However, a properly formed fistula is less likely than other kinds of vascular access to form clots or become infected. Also, properly formed AV fistulas tend to last many years—longer than any other type of dialysis access.
An AV graft is a surgical insertion of a special tube that connects to a vein and an artery. It becomes an artificial vein and is used like a fistula. If you have small blood vessels that won’t develop into a fistula, an AV graft may be a good option for you.
An AV graft doesn’t need time to mature as a fistula does, so it can be used sooner after its placement, often within 2 or 3 weeks. Compared with properly formed AV fistulas, AV grafts tend to have more problems with clotting and infection, and need replacement sooner. However, a well-cared-for AV graft can last several years.
Central Venous Catheter
If your kidney disease has progressed quickly, you may not have time to get a permanent dialysis access before you start hemodialysis treatments. You may need to use a central venous catheter as a temporary access. A catheter is a tube inserted into a vein in your neck, chest, or leg near the groin.
Central venous catheters are not ideal for permanent access. They can clog, become infected, and cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, a central venous catheter will work for several weeks or months while your permanent access develops.
For some people, AV fistulas or AV grafts are unsuccessful and they need to use long-term catheter access. Central venous catheters that will be needed for more than about 3 weeks are tunneled under the skin to increase comfort and reduce complications. However, even tunneled catheters are more prone to infection than AV fistula and AV grafts.
Your healthcare team will help you choose the best long-term dialysis access for your situation. If you already have an AV fistula/AV graft that is not functioning properly, or if you need a central venous catheter, speak with your doctor and contact us. We can diagnose and treat you to get your access functioning. Please contact us at (804) 828-2600 or email us at firstname.lastname@example.org.