Before you can begin hemodialysis, you will need a vascular access. This is an area on your body where two needles will be inserted before each dialysis session to allow your blood to flow in and out of your body. Your blood will flow through one needle from your vascular access to the dialysis machine, and then and from the dialysis machine back to your body through the other needle.
There are two types of vascular access that are best for dialysis. Work with your doctor to figure out which one is best for you.
The AV fistula is the safest and most reliable type of vascular access. AV stands for arteriovenous. An AV fistula is a connection between an artery (a large blood vessel that carries blood from your heart) and a vein (a blood vessel that carries blood to your heart). In order to make an AV fistula in your body, you will need to have a minor surgery to connect your artery to your vein. This is most often done in your non-dominant arm. For example, if you are right-handed, you would probably get your fistula in your left arm.
Once the artery and vein are connected, more blood is able to flow through the fistula. After two to three months, the fistula will be stronger than a normal artery or vein, and will be able to withstand having needles put in and taken out many times per week. Because the fistula needs time to heal and become strong, it is best to get an AV fistula two to three months before you need to start dialysis.
An AV graft is the next best vascular access option. Instead of connecting your artery directly to your vein, an AV graft uses a plastic tube to connect the artery and vein inside your body. Like an AV fistula, the AV graft is made by a doctor during a minor surgery. An AV graft is usually ready to be used in just two to three weeks. However, AV grafts are more likely to have problems with infections and blood clots. You must take good care of your AV graft to make it usable for as long as possible.
Other vascular access options
If you find out your kidneys are failing and you need to start dialysis right away, your doctor may recommend that you get a venous catheter. A venous catheter might be used if you have acute kidney failure or if there is not enough time to get an AV fistula or AV graft before you need to start dialysis. A venous catheter is a tube that is inserted into a vein in your neck, chest or leg and hangs outside your body from an opening in your skin. Catheters often have problems with infection, blood clots and scarring. Therefore, this type of vascular access should only be used for short periods of time.
If you cannot get an AV fistula or AV graft, your doctor might recommend that you get a tunneled catheter. This type of catheter is a tube that goes under your skin and connects to a large vein deeper inside your body. It can be used for longer periods of time than a normal venous catheter. A tunneled catheter is safer than a regular venous catheter, but still has problems with infections and blood clots more often than AV fistulas and AV grafts.
Caring for your vascular access
Because your vascular access allows you to get the treatment you need, you might call it your “lifeline.” It is important to take care of it to protect your health and to make sure your access is useful as long as possible.