A crucial step before starting hemodialysis treatment is preparing vein access, usually in your arm or leg. A high volume of blood is continuously removed and returned during dialysis, so we want to maximize the amount of blood cleansed in each treatment.
There are three access options for the dialysis patient:
An AV (arteriovenous) fistula is a surgical connection of one of your own arteries to a vein under the skin of your arm. It’s the most natural dialysis access because it’s made with your own blood vessels. An AV fistula requires planning ahead, because the fistula takes awhile to develop after minor surgery. AV fistulas are less likely than other techniques to form clots or become infected, tend to last many years and can be tolerated by most people. However, if your veins are too small or too weak for a fistula, there are other options.
An AV graft is a surgically inserted tube that connects to a vein and an artery as an artificial vein and fistula. If you have small blood vessels that won’t develop into a fistula, an AV graft may be a good option. It can be used sooner after placement, often within two or three weeks. AV grafts may have more problems with clotting and infection, and need replacement sooner. However, a well-cared-for AV graft can last several years.
Central Venous Catheter
If your kidney disease has progressed quickly, or an AV fistula or graft is unsuccessful, you may not have time to get a permanent dialysis access before you start hemodialysis treatments. A central venous catheter in your neck, chest or near the groin is a good and usually temporary solution. Central venous catheters are not ideal for permanent vein access, because they sometimes clog, become infected or cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, they will work for several weeks or months while your permanent access point develops. If they are needed for more than a few weeks, they will often be placed under the skin for more comfort and a lower risk of complications.