Dialysis Access

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.

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