Dialysis acccess | Kidney Campus

In order for dialysis to occur, an access needs to be created surgically on your body. Depending on the type of dialysis you choose, (peritoneal vs. hemodialysis) the location of the dialysis access site is different. All of them cause some changes to your body.

Hemodialysis

There are three types of dialysis access options for hemodialysis: fistula, graft, and central venous catheter.

Fistula

BAX 134060 MISC HD Technical support 2021

Adapted from the Oxford University Hospitals¹

A dialysis fistula is a permanent access made by surgically linking your artery to a vein in your arm or sometimes your leg. In hemodialysis, your blood is removed from your body through a needle inserted in the fistula, and then pumped through a dialyzer (filter) to remove the waste and excess fluids from your blood. The clean blood is then returned to your body through a second needle inserted in the fistula. After a fistula is made, it takes at least one month and ideally 3–4 months to mature enough before it is used for HD. Over time, the dialysis fistula will get bigger because of the blood pressure in the artery, which is a good sign that the fistula is working well. The fistula is the best access choice for hemodialysis and is less prone to infection because it uses your own blood vessels and is under your skin.² Sometimes the first attempt at making a fistula does not work and other surgeries are needed. A healthy fistula can last decades, but not everyone can have a fistula. Speak with your doctor for more information.

Graft

A graft is surgically made by linking one of your arteries and a vein with tubing. Since the tubing (or referred to as artificial vein) is not native to your body, the risk of blood clots and infection is higher than with a dialysis fistula. Grafts may need to be replaced at some point as the dialysis needles can cause holes in the graft tubing, which can lead to severe blood loss. Most often the graft site is in one of your arms, but thigh and leg grafts may also be used as other sites are used up over time.³

Central venous access

Central venous catheter (CVC) is an access or entry to the bloodstream. A small soft tube (catheter) is placed into a large vein in the neck, shoulder or groin area that feeds towards the heart. CVCs do not require needles for the delivery of hemodialysis. However, CVCs have the highest rate of infection of all HD access options and risk of blood clots.⁴

REFERENCES:
1. Oxford University Hospitals. The oxford Kidney Unit: Access for haemodialysis. Available at: https://www.ouh.nhs.uk/patient-guide/leaflets/files/40915Phaemodialysis2.pdf Accessed on February 22, 2021.
2. Schatell, Dori MS, and Agar, John MD. Help, I need dialysis! How to have a good future with kidney disease. Madison, WI: Medical Education Institute, Inc. 2012. p. 42–44.
3. Schatell, Dori MS, and Agar, John MD. Help, I need dialysis! How to have a good future with kidney disease. Madison, WI: Medical Education Institute, Inc. 2012. p. 51.
4. Schatell, Dori MS, and Agar, John MD. Help, I need dialysis! How to have a good future with kidney disease. Madison, WI: Medical Education Institute, Inc. 2012. p. 53.

Peritoneal dialysis

For peritoneal dialysis to happen, a peritoneal dialysis catheter is surgically placed in the abdomen to access the peritoneal membrane. Dialysis solution flows into your abdomen through the peritoneal dialysis catheter to clean your blood using your own peritoneum as the filter.

Peritoneal dialysis catheter¹

A PD dialysis catheter is a small tube that is surgically inserted through the wall of your abdomen. The placement of the PD catheter only takes 15–30 minutes and is done in an operating room or in the radiology ward. The tube, about the size of a drinking straw, reaches into the peritoneum that is used as the filter in peritoneal dialysis. The place where the tube comes out of your body is called the exit site. You need to keep your catheter clean and dry to avoid infection and always handle with care so it does not become damaged.

One option is to have your exit site at your chest area. This is called a parasternal PD dialysis catheter. The catheter tip still reaches down to the abdomen but it is tunneled further under the skin to exit at the chest. The risk of infection is lower with a parasternal PD catheter as the skin on the chest moves less and is thinner than on the abdomen and there is less risk of infection.

REFERENCE:
1. Schatell, Dori MS, and Agar, John MD. Help, I need dialysis! How to have a good future with kidney disease. Madison, WI: Medical Education Institute, Inc. 2012. p. 39–40.