Helping you live a better life on dialysis

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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 diagram of a Fistula and a Graft

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
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