Creating Access

How is Blood Removed and Replaced?

In order to do hemodialysis, there must be some type of access to the blood. The doctor will discuss the best type of access for each person.

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. It is the direct linking of an artery to a vein, and allows for access to the blood for dialysis using two needles. It requires a surgical procedure, typically performed by a vascular surgeon and is usually placed in a patient’s non-dominant arm. The access takes up to six weeks to heal and mature before dialysis can begin.

The advantages of using a fistula are:

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

Complications are few, but can include the possibility of an aneurysm, or a weakness in the wall of the blood vessel, forming at the site of the fistula or cold hand or fingers. Tell your physician or renal care team if any complications or concerns arise.

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

The advantages of a graft include:

  • Grafts may be placed in an arm or thigh.
  • Typically heals faster than a fistula, so patients can undergo dialysis sooner.

Risks include infection and narrowing of the vein where the graft is attached.

3. Venous Catheter “” When you need a more immediate, temporary access for dialysis, doctors will consider placing a catheter. A venous catheter is typically placed in your chest, near your collar bone. These types of access are 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 their fistula or graft.

Complications can include infections, narrowing of the veins, and a higher risk of blood clots.