Options for Dialysis Access
MO-10-13-CKD
This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid
Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy
Why dialysis access?
When your kidneys fail, dialysis is often
required if transplantation cannot be
done.
Dialysis replaces kidney and access is
crucial for those whose kidneys have
failed.
Dialysis Options
There are two form of dialysis.
One type of dialysis is performed using
the abdominal cavity (peritoneal
dialysis)
Another type is performed by filtering
the blood (hemodialysis)
Peritoneal Dialysis Access
Peritoneal dialysis requires access to the
peritoneal cavity.
During a minor outpatient surgery, a small
soft tube is put into the abdomen called a
PD catheter.
Peritoneal Dialysis Catheter
One end of the catheter rests in the
peritoneal cavity, while the other extends
from the body.
It takes a few weeks to heal.
The PD catheter stays in place throughout
your time on PD.
Peritoneal Dialysis Catheter
National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov
Hemodialysis
Hemodialysis circulates blood through a
machine outside of your body to remove
toxins and excess fluid.
The machine then pumps the cleansed
blood back into your body.
Hemodialysis Access
Dialysis access refers to the creation of
an entranceway into the bloodstream so
that the blood can be cleansed by the
dialysis procedure.
Hemodialysis Access
This entrance way is commonly located
in the arm, the leg, or the neck.
The best type of dialysis access is
provided by a fistula
Types of Hemodialysis Access
Fistula (arteriovenous fistula)
Graft (arteriovenous graft)
Catheter
Preparation for Access
Ideally before you start dialysis a access
should be in placed and ready to use
Fistula should be placed 6 months prior to
starting dialysis
Graft should be placed 3-6 weeks prior to
starting dialysis
Preparation for Access
Before an access is placed, you will need to
see a surgeon for evaluation.
The surgeon will do certain procedures
before deciding what access is right for you.
Preparation for Access
These procedures are
–
Noninvasive vein mapping with an
ultrasound to help determine which
veins can be used
–
Blood lab tests
What is a fistula or AVF?
Is created by directly connecting an artery and
a vein
This causes the vein to grow larger and
stronger for easy access
Fistulas can be place in forearm or upper arm
Fistula or AVF
It is done as minor outpatient surgery
Usually take 6 to 12 weeks to develop
Considered the best long-term vascular
access because it provides adequate blood
flow, lasts a long time, and has a lower
complication rate than other types of access.
AVF Diagram
Pros of AVFs
The gold standard
Lasts longer than other access types, usually 20
plus years
Fewer infections than grafts and catheters
Increased blood flow means more effective dialysis
treatment
Cons of AVFs
Visible as a bulge under the skin
Takes longer to develop for use
Not always possible for all patients
Graft
If your veins are small or weak then graft is
a better option for dialysis access.
A graft connects an artery to a vein using a
soft artificial tube implanted under your
skin.
AVGraft
Grafts can be placed in your arm or leg
but most are placed in the forearm
Can be used after 3-6 weeks of
placement
AVGraft Diagram
Pros of Graft
Implanted during minor outpatient surgery
Can be used within 3-4 weeks
Cons of Graft
Usually only lasts 3-5 years
More likely to get infected than AVF
More likely to have blood clots than an AVF
Longer bleeding time than an AVF after
dialysis needles are removed
Catheter
If your kidney disease has progressed
quickly, you may not have time to get a
permanent vascular access before you
start hemodialysis treatments.
You may need to use a venous catheter
as a temporary access.
Catheter
A catheter is a tube inserted into a vein
in your neck, chest, or leg.
It has two chambers to allow a two-way
flow of blood near the groin.
Pros of Catheter
Dialysis can be performed immediately after
placement
Easy to remove and replace
Cons of Catheter
Highest infection rate
Direct line to the heart contributes to more serious life
threatening infections
Clots more frequently
Difficult to obtain sufficient blood flow to allow for effective
removal of waste materials through dialysis
Bathing and swimming are not recommended due to infection
risks
Not a permanent access option
Take Home Messages
There are many factors that go into
deciding which type of vascular access is
best for you.
Be a well-informed and knowledgeable
patient who has all the facts.
Take Home Messages Continued…
Educating yourself is the first step
toward being in control of your dialysis
and healthcare.
Choosing a fistula is your best choice.