Access Options & Care
Hemodialysis access is the way you reach your blood for the procedure. To allow blood to flow from you to the dialyzer and back, you need a large blood vessel with good blood flow. To create a vessel that is large enough, an access to your blood is created with outpatient surgery, usually in your arm or leg.
Choosing your access is a decision that you and your doctor will make early in your treatment. It will take several weeks to a few months for your access to heal or “mature” and be ready to use for dialysis.
Fistula
A 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 access because it’s made with your own blood vessels. Most people can have a fistula. However, if your veins are too small or too weak for a fistula, there are other options.
Pros
- Less chance of infection than other types of access
- Less chance of clots forming than other types of access
- Usually works for many years—sometimes decades
- Usually needs fewer “tune-ups” (revisions) to repair
- Can use the Buttonhole Technique for needles
Cons
- Can be seen on your forearm
- May take time to develop
Graft
A graft is a surgical insertion of a special tube that connects to a vein and an artery and is used like a fistula.. If you have small blood vessels that won’t develop into a fistula, a graft may be a good option for you.
Pros
- Does not have to “mature” like a fistula, so it can be used with a few weeks after surgery
- Permanent access option if a fistula won’t work
Cons
- Has a higher risk of clotting than a fistula has
- Has a higher risk of infection than a fistula has
- Doesn’t last as long as a fistula (a few years at most)
- Need “tune-ups” (revisions) in the hospital one or more times a year
- Can be seen on your forearm
Central Venous Catheter
A catheter is a long plastic tube, shaped like a “Y”. A doctor places it under the skin of your chest, into your neck (see picture). The “stem” of the Y is in your heart. The two ends of the Y come out through the skin of your chest. For dialysis, the machine tubing connects to each end of the Y. The Y catheter can be placed and used the same day, and is primarily used when a patient needs emergency dialysis and no other access is available. Long-term use of a central venous catheter is discouraged because of potential complications that can occur.
Pros
- Once the catheter is placed, no needle contact for the patient
- Can be used right away for hemodialysis
Cons
- There is a very high risk of clotting
- There is a very high risk of life-threatening blood infections
- May cause narrowing of the vein in which it is placed, which makes future permanent access on that side of the body less likely
- Catheters may need to be changed often
- Blood flow rates are lower, so longer treatment times might be necessary
- You can’t get the catheter wet, so swimming is off-limits and showers may not be possible
