Dialysis Access

Our board certified vascular specialists at the Vascular & Interventional Pavilion (VIP) have performed many dialysis access procedures in our comfortable, fully accredited outpatient facility in St. Petersburg, Florida.

Dialysis access procedures create an easy way to access your bloodstream, allowing blood to be removed and returned quickly, efficiently, and safely during a dialysis treatment. The access point is usually in your non-dominant arm or leg.

Hemodialysis is a treatment for patients with acute or chronic renal failure. An artificial kidney (dialyzer) acts as a semi-permeable membrane between the dialysate and blood and will remove water and toxins from the blood. Vascular access is required to perform the treatment. The following will describe in detail about hemodialysis access and what to look for after the procedure. Internal vascular access is required to receive hemodialysis treatments. There are two types of internal vascular access which are surgically placed.

Arteriovenous Fistula
The arteriovenous fistula involves connecting an artery and vein together. The purpose of doing this is to cause the vein to become distended, creating a large vessel in which hemodialysis can be performed. The fistula is usually created in the lower or upper arm.

Advantages to arteriovenous fistulas are:

  • A low risk of infection or clotting
  • Less need for revision
  • Unrestricted use of the arm or leg

Disadvantages to arteriovenous fistulas are:

    • Not ideal in patients with small veins
    • There is risk of steal syndrome (where too much blood goes through the fistula)

Arteriovenous Graft

The arteriovenous graft involves the use of a tubular Teflon graft material that is connected to an artery and a vein. This creates an artificial vein which is used to perform hemodialysis treatments. The graft is usually placed in the upper or lower arm.

Advantages to arteriovenous grafts are:

  • Unrestricted use of grafted arm or leg

Disadvantages to arteriovenous grafts are:

  • There is a risk of clotting from low blood pressure (hypotension)
  • There is a risk of tissue around the graft becoming infected
  • Risk of steal syndrome.

Instructions following the procedure:

  • Keep the extremity elevated for at least twenty-four to forty eight hours to reduce swelling. Remember some swelling is expected following the procedure.
  • Do not get the surgical site wet, until the sutures are removed.
  • Do not allow blood pressure, intravenous needles (IV’s), or blood drawing from the access arm.
  • Avoid carrying heavy items draped over the access arm or wearing restrictive clothing. Items such as wristwatch, bracelet, or shoulder pocketbook should not be used on the access arm.
  • Avoid sleeping on the access arm.
  • Check for a pulse or bruit thrill in the access once a day or after any episodes of low blood pressure, dizziness, or lightheadedness.
  • No driving until you see the provider in the office for your follow up visit.
    No heavy lifting.
  • Squeeze a small ball intermittently throughout the day.

Notify the MD for the following:

  • Unable to feel a pulse in the access extremity.
  • Drainage or bleeding from the surgical site.
  • Temperature greater than 101F.

Dialysis Access Procedures

There are two types of access – fistulas and grafts. A fistula is created by joining an artery to a vein using your own tissue. A graft connects an artery to a vein with a man-made tube.

For both fistulas and grafts, the connection between your artery and vein increases blood flow through the vein. In response, your vein stretches and becomes strengthened. This allows an even greater amount of blood to pass through the vein. In the weeks after surgery, the fistula begins to mature. The vein increases in size and may look like a cord under your skin.

The whole process takes up to 3 months before the access is mature enough to use for dialysis. Once matured, a fistula should be large and strong enough for dialysis technicians and nurses to insert the large dialysis needles easily. You can usually begin using your graft in 2 to 6 weeks, when the fistula has healed sufficiently.

Fistulas are typically preferred to grafts because fistulas are constructed using your own tissue, which is more durable and resistant to infection than are grafts. However, if your vein is blocked or too small to use, the graft provides a good alternative.

What to Expect

You will begin with a comprehensive exam with one of our board-certified vascular surgeons and our experienced clinical staff. You may also undergo vascular testing in our convenient onsite vascular lab in St. Petersburg. Our staff will schedule a convenient appointment time for you to return to the office for the procedure.

Your surgeon will choose an access site based on whether you have a history or symptoms of arm or leg artery disease. Hardening of the arteries, which reduces blood flow to the arms or legs, causes these conditions. We will not choose an area of the body with reduced circulation.

Dialysis access sites are usually placed in arms rather than legs because atherosclerosis is more common in the legs. Also, if it will be placed in an arm, the vascular surgeon will usually choose the non-dominant arm.

Patients are advised not to eat or drink anything for eight hours prior to the procedure (since we usually schedule procedures in the morning, this will mean not to eat or drink anything after about 9 pm the night before the procedure).

For the procedure, you will be sedated and then we will numb the area where the fistula or graft will go.

To perform the procedure, the surgeon joins an artery and a large vein under the skin by dividing the vein and sewing it to an opening made in the side of the artery. As a result, blood flows into the veins that lead back to the heart, and also down the arteries into the hand. The blood normally traveling in the divided vein goes back to the heart through other veins. If you cannot receive a fistula because the vein is too small or blocked, we may construct a graft using a piece of man-made material.

After the Procedure

When the procedure is finished, you will be moved to our comfortable recovery area where you will stay for several hours while our staff monitors you for any complications. You will be asked to keep the access area raised above your heart to reduce any swelling and pain. We may prescribe a mild painkiller or recommend an over-the-counter painkiller.

You will then be released to go home with a caregiver or family member. We will provide post-op instructions upon discharge. You should avoid lifting heavy weights (over 10 pounds), and you should keep the incision dry for at least two days. We will also recommend a mild exercise program to strengthen the muscles around the access site.

Using the Access Sites for Dialysis

Sometimes access sites can take weeks or even months until they are ready for dialysis use. Until the access is ready, you may have to use a catheter for dialysis. Grafts mature more quickly than fistulas. They sometimes can be ready in 2 to 3 weeks, but the surgeon may recommend waiting 4 to 6 weeks before using a graft. Grafts usually last for about 1-2 years, but fistulas can last up to 7 years if cared for properly.

For more information about dialysis access procedures offered by VIP surgeons, please contact the Vascular & Interventional Pavilion today or request a free consultation online now.

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