Types of vascular access for hemodialysis (2023)

If you need dialysis for your treatmentkidney failure, you must use one of three types of vascular access to facilitate your dialysis: an arteriovenous (AV) fistula, an AV graft, or a venous catheter. All three provide the vascular access needed for regularly scheduled dialysis sessions, but there are some differences between them. You and your doctor must decide what is best for you.

The need for dialysis

The association between renal failure and vascular access is significant. Your kidneys act as filters to remove toxins from your body and adjust the concentration of fluids and nutrients.You keep what you need in your blood while producing urine that contains what you don't need.

A person without kidney function is unlikely to live more than a few weeks without treatment. If your kidneys fail, thenresolution— the life-saving way of cleaning your blood to rid your body of waste — is essential.

guys

Hemodialysis provides a "spare kidney" to filter your blood and eliminate toxins. There are two different types of hemodialysis: hemodialysis and peritoneal dialysis.There are pros and cons to each, and you and your doctor can decide which type is best for you.

PeritonealdialyseThis is done using a catheter (tube) and a special fluid that is pumped into the stomach to filter waste. BlutdialyseIn the more common type of dialysis in the United States, your blood is filtered using a machine. Hemodialysis is performed through a vascular access that connects your blood vessels to the machine.

vascular access

Through the vascular access, blood can be taken from your body and sent directly to a dialysis machine, where it is cleaned of toxins and excess fluid. The filtered blood then flows back into the body via the vascular access. All three types of hemodialysis allow this, but there are some key differences between them.

Arteriovenous (AV) fistula and graft

The term arteriovenous refers to the blood that flows from the artery to the vein. Arteries are blood vessels that carry oxygen-rich blood from the heart to various organs. Veins are the blood vessels that carry deoxygenated blood back to the heart.

Arteries and veins are not usually directly connected to each other, as blood travels from the arteries to the veins through small capillary connections. An AV access is a surgically created direct bridge between an artery and a vein that bypasses the capillaries.

There are two kinds:

• AV Fistula:The bridge is formed with the help of the body's own blood vessels.
• AV Transplant:The bridge is made of artificial material.

An AV fistula is usually preferred over an AV graft because it usually lasts longer, works better, and is less prone to infection or blood clots.Blood vessels in good condition are required for an AV fistula. If you don't have open, smooth blood vessels, you may need an artificial AV graft.

Proceedings

An AV fistula and AV graft are created by procedures performed in the operating room or in an operating room.

This is usually an outpatient procedure that takes one to two hours. They're usually performed on your non-dominant arm (the arm you don't use for typing). To prevent pain, you will need a local anesthetic or nerve block.You may also need oneintravenous sedation, which can help you sleep or rest, but that way doesn't require respiratory supportgeneral anestheticI do.

An artery and vein are selected, severed (transected), and surgically sewn together directly or through suturehe can. The connection between artery and vein remains completely in the body.

Use

Both procedures allow for rapid blood flow, allowing you to dialyze all of your blood in a relatively short amount of time. This is possible because the bridge between the artery and vein causes the vein to widen, which is usually narrow compared to an artery. The wider vein can also make it easier for your nurse to insert a needle for your dialysis if your veins are thin and difficult to reach.

Each time you go on dialysis, you insert a needle into the venous side of your AV fistula or graft to feed blood to the machine, and another needle is inserted into the arterial side to pump the filtered blood back into your heart to guide body.

complications

Blood clots that come back can happen if you have severe vascular disease or a blood clot, or if you smoke. This can prevent blood flow through the graft or fistula, requiring the use of blood thinners or placement of a new graft.

If you experience swelling, pain, or numbness in your arm, there may be a problem with the graft and you should see a doctor.

Care

You must take care of your AV arm and avoid excessive strain or pressure while using the fistula or graft for dialysis. Otherwise it should work pretty well unless a blood clot forms.

It's also important to stay healthy because infection can occur if you have a problem with your immune system or if you have a systemic infection, such as an infectionSepsis.

Venous Catheter

A venous catheter is a tube that is inserted into one of the large veins in the neck or groin. One end of the catheter remains in the vein and the other end of the catheter remains outside the body. It does not form a bridge between an artery and a vein. The outer end of your catheter has several connectors, one for drawing blood into a dialysis machine and the other for pumping blood from the machine back into your vein.

A venous catheter is inserted for a short time,before your AV graft or fistula is ready or if you need emergency dialysis for a few weeks or months. It can be used immediately and placement requires surgical intervention. The venous catheter stays in place for repeated use and does not need to be inserted every time you need dialysis.

You need to take extra care with an IV catheter and make sure it stays clean and secure to avoid malfunctioning, falling out, or infection.

A word from Verywell

If you suffer from kidney failure, you need close medical attention. Regardless of whether you are a candidate or considering onekidney transplant, dialysis is an important part of your medical treatment. By learning as much as you can about your kidneys, how they work, and how to care for your vascular access, you can master the complex, life-saving process of dialysis.