Hemodialysis

Dialysis is a treatment for kidney failure.  It helps replace the work of the kidneys when they have stopped working.  Hemodialysis is a type of dialysis.

What is hemodialysis?

Hemodialysis is a way of cleaning wastes and extra fluids from your blood using a machine.

In hemodialysis, blood goes through a tube from your body  to a special filter called a dialyzer.  The dialyzer filters waste and extra fluid from your blood.  Then, the “clean” blood travels through another tube and back into your body.

Where can I get hemodialysis treatments?

In most cases, hemodialysis is done at a dialysis center.  This is sometimes called “in-center hemodialysis.”  Your doctor will decide how often you need treatment, but most people have in-center hemodialysis treatments three times per week.  Each treatment usually lasts about three to five hours. 

Some things to consider about in-center hemodialysis are:

• You may need help getting to and from the dialysis center.
• Some centers have more flexible hours than others.
• Your doctor may only work with a few dialysis centers in your area.
• During your hemodialysis treatments, you can several activities.  Many people use their time at the dialysis center to:
• Read a book
• Listen to music
• Play hand-held video games
• Do crossword puzzles
• Take a nap

In some cases, hemodialysis can be done at home.  This means that you (and usually a partner) would need to be trained on how to insert needles and run the machine.  Many dialysis centers have staff that can train you to do home hemodialysis.

What is an access?

For hemodialysis, blood is taken from your body, cleaned and returned to your body.  This happens through a place on your body called an access (or vascular access).  There are three types of access:

1. Fistula
   
   A fistula (also called an AV fistula) is a place where one of your arteries connects to one of your veins.  Your fistula would be created during a minor surgery and would need time to heal and “mature” before it can be used.  Then, during dialysis treatments, needles will be put into your matured fistula.
   
   In most cases, your fistula will be placed in your non-dominant arm.  This means that if you are right-handed, your fistula would likely be in your left arm. 
   
   A fistula is the best kind of access.  It is the least likely to get clots or infections.  Fistulas also tend to last longer than other types of access.  But, because fistulas can take longer to heal, it is important to plan ahead.  Talk to your doctor about your options and whether a fistula is right for you.
   
   
2. Graft
   
   A graft (also called an AV graft) is a special tube that connects an artery and a vein in your arm.  Like with a fistula, a graft would be placed under your skin during a minor surgery.  Your graft will need time to heal, too, but it probably won’t take as long as a fistula to be ready.  During dialysis treatments, needles will be put into the graft.
   
   In most cases, your graft will be placed in your non-dominant arm.  This means that if you are right handed, your graft would likely be in your left arm.
   
   Grafts are not as safe as fistulas.  They are a little more likely to have infections or get clots.  Still, many people do well with grafts.  Talk to your doctor about your options and whether a graft is right for you.
   
   
3. Catheter
   
   A catheter is a tube that goes directly into a vein in your neck or leg.  During dialysis treatments, the machine takes blood from your catheter and returns blood to your catheter.  This means that you won’t have needle sticks at each treatment, like you would have with a fistula or a graft.  But catheters are more likely to get infected or have clots.  For this reason, catheters are only recommended in emergencies or for short-term use.

How should I care for my access?

Caring for your access is very important!  Your access lets you have the treatment you need in order to live.  Take good care of your access, no matter which kind you have.

To care for fistulas and grafts:

• Keep the area clean
• Use your access only for dialysis
• Do not have blood tests or check blood pressure on your access arm
• Avoid having tight clothing or jewelry near your access
• Protect your access from bumps and cuts
• Avoid lifting heavy objects
• Try not to lay or sleep on your access
• Learn how your needles will be placed for dialysis (The staff at your dialysis center can help you with this.)
• Make sure that the staff at your dialysis center checks your access at each treatment
• Tell your doctor right away if you notice any swelling, redness or other changes in your access

To care for a catheter:

• Make sure that all clamps are closed and caps are on tight
• Protect the area from water and dirt as much as possible
• Keep the area clean, dry and bandaged
• Clean and re-bandage the area at each treatment (The staff at your dialysis center can help, but make sure that you know how to do this at home in case the bandage becomes wet or dirty between treatments.)
• Tell your doctor right away if you have a fever or notice any swelling, redness or other changes around the access

Revised 12/10.
© Copyright 2010 American Kidney Fund.