Vascular Access for Dialysis

Is crucial to ensure efficient and effective treatment for patients with end-stage kidney disease. The most common types of access include fistulas, grafts, and catheters. A fistula is a surgically created connection between an artery and a vein, usually in the arm, which strengthens the blood vessels and provides a reliable site for needle insertion. A graft involves the placement of a synthetic material to join an artery and vein, similar to a fistula but with slightly higher complication risks. A catheter is a temporary access option, involving the insertion of a soft tube into a large vein, typically in the neck or chest, allowing immediate dialysis but with a higher risk of infection.

Arteriovenous (AV) fistula

An arteriovenous fistula (AV fistula) is a connection between artery and vein that is created by a surgeon. This surgery creates a large blood vessel that not only can sustain suction pressure of the dialysis machine but also has lots of blood flowing through it. An AV fistula is usually created at wrist and elbow. Based on the area at which fistula is created, the fistula access can b taken either along the forearm, or along the arm respectively. During dialysis treatments, the technician inserts needles into the AV fistula to get access to bloodstream.

Arteriovenous (AV) graft

An Arteriovenous graft (AV graft) is a soft rubbery tube that a surgeon implants (i.e., surgically placed) into arm. An AV graft is usually implanted in arm but may also be implanted in forearm, leg or chest. An AV graft is considered inferior to a AV fistula as it is a synthetic material which can get thrombosed/ infected easily. For dialysis, the technician inserts needles into the tube to get access to bloodstream. This process can happen by 2-3 weeks when a AV Graft is used.

Catheter

A catheter (or venous catheter) is a tube placed into a vein, usually in  neck or upper chest. Catheters are usually temporary and used only for a short time. For example, you may need a catheter if you need dialysis right away and the surgery to create an AV fistula or AV graft is still healing.

AV fistula and AV graft are used for permanent, long-term access to your bloodstream, and can last for years. AV fistulas and grafts are under your skin, so they are less likely to cause infections and blood clots than catheters.

Other types of vascular access devices

A HeRO (Hemodialysis Reliable Outflow) device is for people on dialysis who have problems with their AV fistula or AV graft. It allows more blood to flow in and out of the body compared to a catheter.

Which kind of vascular access is best?

The best type of vascular accessis always a AV fistula. It is recommended that an AV fistula is to be created 6-7 months before a patient undergoes dialysis (usually in stage 4-5 kidney disease). This is because an AV fistula requires around 6-10 weeks for it to get ready for dialysis. This is called maturation of AV fistula. During emergencies, a temporary catheter / permacath can be placed for immediate dialysis. AV graft is considered when there are no possible AV fistula access that can be created.

It is essential to consult with a healthcare professional to determine the most suitable vascular access for each unique situation, ensuring safety, efficiency, and patient comfort.

Why is it important to care for vascular access?

Caring for vascular access is crucial because it ensures the proper and safe delivery of medications, treatments, and for dialysis. Proper care helps maintain the functionality and longevity of these access points, minimizing complications such as infections, thrombosis, or damage to the surrounding tissues. Effective vascular access care contributes significantly to patients' overall well-being and successful treatment outcomes.

How should you take care of vascular access?

To take proper care of vascular access, follow these essential steps:

Keep the access site clean and dry: Maintain good hygiene by washing your hands and using a sterile gloves before touching the site. After using, to flush with minimal mixture of heparin and saline so as to prevent thrombosis. While covering it, care should be taken to keep everything sterile and cover it with a waterproof dressing.

Monitor for signs of infection: Look out for redness, swelling, pain, or discharge around the access site. Presence of fever after every dialysis should not be ignored and be reported to your healthcare provider.

Regularly check the function of the access: Ensure the flow of blood through the access is smooth and without any blockages. If you notice any issues, inform your healthcare team.

Avoid activities that may damage the access site: Avoid direct pressure or trauma to the access site, such as lifting heavy objects or inserting needles.

Attend regular appointments: Consult your healthcare provider for routine checks, adjustments, or any necessary maintenance of your vascular access.

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