Vascular Access for Hemodialysis

What is Vascular Access for Hemodialysis

Vascular access is a connection to the blood inside your blood vessels that allows blood to be easily removed from your body and returned to your body during kidney dialysis (hemodialysis).

Hemodialysis is a procedure in which a machine outside of the body filters the blood of a person whose kidneys are no longer working properly. There are three types of vascular accesses:

  • Arteriovenous fistula (AVF). This is a connection between an artery and a vein (usually in the arm) that is made by sewing them together. Blood in the artery flows directly into the vein, causing it to get larger over time. This makes it easier for the vein to be used for hemodialysis. An arteriovenous fistula takes 1–6 months to develop after surgery.
  • Arteriovenous graft (AVG). This is a connection between an artery and a vein in the arm that is made with a tube. An arteriovenous graft can be used within 2–3 weeks of surgery.
  • Venous catheter. This is a thin, flexible tube that is placed in a large vein (usually in the neck, chest, or groin). A venous catheter for hemodialysis contains two tubes that come out of the skin. A venous catheter can be used right away. It is usually used as a temporary access if you need hemodialysis before a fistula or graft has developed, or if kidney failure is sudden (acute) and likely to improve without the need for long-term dialysis. It may also be used as a permanent access if a fistula or graft cannot be created.

Which type of access is best for me?

The type of access that is best for you depends on the size and strength of your veins, your age, and any other health problems that you have, such as diabetes. An ultrasound test may be used to look at your veins to help make this decision.

A fistula is usually the preferred type of access. It can last several years and is less likely than the other types of accesses to become infected or to cause a blood clot within a blood vessel (thrombosis). However, a fistula is not an option for everyone. If your veins are not the right size or if the fistula does not develop properly, a graft may be used instead. Grafts require you to have strong veins. If your veins are not strong enough for a graft, a catheter may be used. Catheters are more likely than fistulas and grafts to become infected or to have a thrombosis.

Sometimes, only one type of access is an option. Your health care provider will help you determine which type of access is best for you.

How is a vascular access used?

The way that the access is used depends on the type of access:

  • If the access is a fistula or graft, two needles are inserted through the skin into the access before each hemodialysis session. Blood leaves the body through one of the needles and travels through a tube to the hemodialysis machine (dialyzer). Then it flows through another tube and returns to the body through the second needle.
  • If the access is a catheter, one tube is connected directly to the tube that leads to the dialyzer, and the other tube is connected to a tube that leads away from the dialyzer. Blood leaves the body through one tube and returns to the body through the other.

What problems can occur with vascular access?

  • A blood clot within a blood vessel (thrombosis). Thrombosis can lead to a narrowing of a blood vessel (stenosis). If thrombosis occurs frequently, another access site may be created as a backup.
  • Infection.
  • Heart enlargement (cardiomegaly) and heart failure. Changes in blood flow may cause an increase in blood pressure or heart rate, making your heart work harder to pump blood.

These problems are most likely to occur with a venous catheter and least likely to occur with an arteriovenous fistula.

How do I care for my vascular access?

Wear a medical alert bracelet. In case of an emergency, this bracelet tells health care providers that you are a dialysis patient and allows them to care for your veins appropriately.

If you have a graft or fistula:

  • A “bruit” is a noise that is heard with a stethoscope, and a “thrill” is a vibration that is felt over the graft or fistula. The presence of the bruit and thrill indicates that the access is working. You will be taught to feel for the thrill each day. If this is not felt, the access may be clotted. Call your health care provider.
  • Keep your arm straight and raised (elevated) above your heart while the access site is healing.
  • You may freely use the arm where your vascular access is located after the site heals. Keep the following in mind:
    • Avoid pressure on the arm.
    • Avoid lifting heavy objects with the arm.
    • Avoid sleeping on the arm.
    • Avoid wearing tight-sleeved shirts or jewelry around the graft or fistula.
  • Do not allow blood pressure monitoring or needle punctures on the side where the graft or fistula is located.
  • With permission from your health care provider, you may do exercises to help with blood flow through a fistula. These exercises involve squeezing a rubber ball or other soft objects as instructed.
  • Wash your access site according to directions from your health care provider.

If you have a venous catheter:

  • Keep the insertion site clean and dry at all times.
  • If you are told you can shower after the site heals, use a protective covering over the catheter to keep it dry.
  • Follow directions from your health care provider for bandage (dressing) changes.
  • Ask your health care provider what activities are safe for you. You may be restricted from lifting or making repetitive arm movements on the side with the catheter.

Contact a health care provider if:

  • Swelling around the graft or fistula gets worse.
  • You develop new pain.
  • Your catheter gets damaged.

Get help right away if:

  • You have pain, numbness, an unusual pale skin color, or blue fingers or sores at the tips of your fingers in the hand on the side of your fistula.
  • You have chills.
  • You have a fever.
  • You have pus or other fluid (drainage) at the vascular access site.
  • You develop skin redness or red streaking on the skin around, above, or below the vascular access.
  • You have bleeding at the vascular access that cannot be easily controlled.
  • Your catheter gets pulled out of place.
  • You feel your heart racing or skipping beats.
  • You have chest pain.

Summary

  • A vascular access is a connection to the blood inside your blood vessels that allows blood to be easily removed from your body and returned to your body during kidney dialysis (hemodialysis).
  • There are three types of vascular accesses.The type of access that is best for you depends on the size and strength of your veins, your age, and any other health problems that you have, such as diabetes.
  • A fistula is usually the preferred type of access, although it is not an option for everyone. It can last several years and is less likely than the other types of accesses to become infected or to cause a blood clot within a blood vessel (thrombosis).
  • Wear a medical alert bracelet. In case of an emergency, this tells health care providers that you are a dialysis patient.
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