Creating Access

How is Blood Removed and Replaced?

Due to the high flow of blood that is needed for hemodialysis, patients and their doctor will discuss creation of an “access.” There are three primary types of access:

  1. Fistula “” A fistula is the preferred option for an access due to fewer complications and better patient outcomes. This involves directly linking an artery to a vein. It is an outpatient surgical procedure, typically performed by a vascular surgeon, and is usually placed on a patient’s non-dominant arm. The fistula takes up to six weeks to mature before it can be used for dialysis.

The advantages of using a fistula are:

  • Higher blood flow, which means more efficient and effective dialysis
  • Lower infection rates because there are no manmade, foreign body materials involved
  • Lower risk of blood clot formation

2. Graft “”Also created in an outpatient surgical procedure, a graft uses a special tubing or donated vein to connect the artery to a vein.

The advantages of a graft include:

  • Grafts may be placed in the lower or upper arm or the thigh.
  • Typically matures faster than a fistula, so patients can undergo dialysis sooner.

3. Venous Catheter “” When you need a more immediate, temporary access for dialysis, doctors will consider placing a catheter in your chest. This type of access is considered for short-term or emergency use.

The advantages of a venous catheter:

  • It’s a viable option for those whose kidney disease has progressed so rapidly that the time delay of healing from a fistula or graft is not an option.
  • It can be used in patients who have problems with fistula or graft surgery.