Published:
September 2, 2022
For people who have advanced kidney disease, there is a possibility that dialysis will become a necessary and lifesaving treatment. During dialysis, either a machine or a membrane in your abdomen does the work of filtering waste, removing extra fluid, and balancing the chemicals in your blood that your kidneys are no longer able to do.
Options for Hemodialysis Dialysis Access
Before you can begin dialysis, however, you first need to have a surgical procedure to create a place where your blood can flow in and out of your body to be filtered. This is called the vascular access. The procedure to create this access is usually performed by a vascular surgeon—a physician with specialized training in treating the circulatory system.
Surgeons typically create an access point in your arm or wrist, connecting an artery to a vein. There are two types of access points: fistula and a graft. In consultation with your nephrologist (kidney doctor), your surgeon will discuss the option best for you. Here is a quick overview of each dialysis access type.
AV Fistula Access for Dialysis
The longest-lasting access is called an arteriovenous, or AV fistula. To create this access for dialysis, your surgeon will connect an artery directly to a vein. A fistula tends to be hold up better than a graft access and is less likely to get infected.
The procedure must be done several months before you start dialysis as the fistula needs time to heal and become strong. The goal is for the access to maintain a steady blood flow and be sturdy enough to be used frequently—usually three times a week—without collapsing. When you begin dialysis, the dialysis nurse will be able to easily connect you to the dialysis machine.
Graft Access for Dialysis
A graft, or bypass graft, is a dialysis access option that may be recommended for people whose veins are smaller or who need to start dialysis sooner. During this procedure, your surgeon implants a tiny tube to connect an artery to a vein.
What to Expect During AV Fistula and Graft Surgery
The surgical procedures for both the fistula and graft are usually done on an outpatient basis and take a few hours. They can be done under general anesthesia or by numbing your arm.
Your surgeon will make a cut on your arm and implant the graft tube or fistula that will connect an artery to a vein.
Someone will need to take you home after the procedure and it’s recommended you take a few days off of work to recover.
Peritoneal Dialysis Catheter
Some patients may be candidates for peritoneal dialysis which uses a natural filter in the lining of your abdomen (the peritoneal membrane) to remove wastes and extra fluid and return electrolyte levels to normal. This does not require a dialysis machine and can be done at home on your own schedule, even at night when asleep.
About two weeks before peritoneal dialysis can begin, a vascular surgeon places a catheter in your abdomen to create a dialysis access.
Understanding Dialysis Access
Getting a vascular access for dialysis—and the entire prospect of dialysis—may feel overwhelming and frightening. Knowing what to expect and asking your care team any questions you may have, can help you and your family prepare for this new way of living with confidence.