Dialysis access is achieved through one of three procedures used to prepare a patient for dialysis treatments. The procedures include insertion of a fistula, graft or catheter that will be used to connect dialysis equipment to the patient’s blood supply.
The most common type of dialysis access is a fistula. A fistula is created during a minor surgical procedure and creates a passageway using the patient’s own tissue to connect a vein to an artery that is nearby. It is typically in the arm. This creates a large blood vessel which increases the speed of the blood flow and improves the efficiency and expediency of dialysis; a treatment for removing waste and extra fluid from the blood when the patient’s kidneys have failed—usually as result of kidney disease.
Needles are used to remove the blood so it can be filtered through the dialysis machine and the purified blood is quickly returned to the patient by needle insertion. It must be placed several months before a patient begins dialysis in order to ensure the vein has time to mature and provide increased blood flow. The time period for maturation of the fistula is typically between three and six months.
Because the fistula is created with the patient’s own tissue, this procedure is likely than the others to encounter issues with infection and clotting and is generally the preferred choice for permanent vascular access.
A graft is the second most common choice for dialysis access. A minor surgical procedure is needed to place a small surgical tube which connects the vein and a nearby artery. The graft is usually inserted in the bend of the arm or the upper arm, but it may also be placed in the leg or chest wall. A graft is normally healed and ready for dialysis use in two to six weeks following placement. Grafts are often used when a patient has small veins that will not develop a fistula properly.
Another option for dialysis access is a peritoneal dialysis catheter. The catheter is placed during a minor surgical procedure into the abdomen where it will transfer fluid in and out of the abdominal cavity. The catheter is a soft, flexible, hollow tube, made of silicone. Multiple holes at the end of the catheter allow the fluid to flow in and out. Two to four weeks after placement, the catheter may be used for dialysis.
During peritoneal dialysis, a cleansing fluid flows through the catheter into your abdomen. The lining of your abdomen acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded.
These treatments can be done at home, at work or while traveling. However, peritoneal dialysis isn't an option for everyone with kidney failure. You need manual dexterity and the ability to care for yourself at home, or you need a reliable caregiver.
To reduce risk of infection for fistula and graft access, it is important that a patient takes special care of the site. Patients must monitor the site for signs of infection, redness, and excess bleeding. It is also a good idea to wash the site with antibacterial soap daily and try to prevent scratching or damage to the skin surrounding the site. If anything unusual is noted like redness, swelling and heat, a patient should contact the dialysis care provider at once.
As for catheter care, patients must ensure the site stays clean and dry and that a clean dressing is applied daily. A protective cover should be used when the patient showers. It is important to notify the dialysis care provider immediately if the patience notices that the catheter’s placement has changed or if the edge (cuff) is showing from under the skin.