Dialysis Access

Dialysis access is the term used when referring to procedures that are performed in helping patients undergo dialysis for kidney failure.  There are two ways to undergo dialysis.  One method is performed by connecting the dialysis machine directly to the patient’s blood flow called hemodialysis. The other method is with the use of a catheter that is implanted in the abdominal cavity called peritoneal dialysis. 

Hemodialysis can be performed by two different methods.   The first is with the use of a catheter.  These catheters are typically placed in the large vein in the neck called the jugular vein and can be left in place for weeks to months.  Generally, catheters for dialysis are considered temporary and over the long term, can put patients at risk of dangerous infections.  Therefore, if a catheter is needed over the short term to perform hemodialysis, most patients will require a more permanent type of hemodialysis access.

There are two permanent types of hemodialysis access.  These include fistulas and grafts.  A hemodialysis fistula is when the vascular surgeon uses the patient’s own vein in the arm (the tube that carries the blood back to the heart) and connects it to a nearby artery (the tube that carries the blood away from the heart).  By connecting these two blood vessels, high blood flow is created in the vein which then allows the vein to become larger and thicker. Once mature, the dialysis fistula can then be accessed by the nurses using needles. The other type of permanent hemodialysis access is a graft.  A graft is a synthetic tube that is placed underneath the skin in the arm and connects the artery and vein.  Typically, fistulas are more durable than grafts.  Not every patient has an optimal vein to create a fistula.  In those cases, a hemodialysis graft is placed.

The surgery for hemodialysis access is very well tolerated.  Most patients need only local anesthetic placed in the arm combined with sedation.   The operations typically last one to two hours and patients can go home the same day.  A hemodialysis fistula takes approximately 6-12 weeks to become mature.  In contrast, a hemodialysis graft takes approximately 2-3 weeks to heal in order to access.  Nevertheless, a hemodialysis fistula is the preferred method in most patients because long-term durability remains better.

Peritoneal dialysis is performed for some patients who are able to undergo dialysis treatment at home.  By placing a catheter into the abdominal cavity, patients infuse special fluid which then allows the body to form an equilibrium and remove toxic products.  Vascular surgeons also perform these types of procedures.  There are different types of peritoneal catheters of which some exit the skin from the abdominal wall or others from the upper chest.  Most patients prefer a peritoneal dialysis catheter that exits the skin from the upper chest.  The reasons for this include the ability to take a bath and not have the catheter under water; less irritation in the belt line; less likely to have infection.

The operation for a peritoneal dialysis catheter requires patients to go to sleep with general anesthesia.  Typically, an incision is made in the abdomen as well as the upper chest and the catheter is placed underneath the skin and exits the upper chest.  The operation takes 1-2 hours and the large majority of patients can go home the same day.  In approximately 4-6 weeks, after healing, the catheter is ready to begin the exchanges of fluid.   The vascular surgeons at SIU Healthcare have extensive experience with dialysis access.  Additionally, many of the faculty have access to research trials with cutting edge techniques to help patients have better outcomes when needing these types of surgeries.  If you need hemodialysis access surgery, please call 217-545-8000.

Here are some web links for further education about dialysis access:

• Vascular Web
• National Kidney Foundation
• Fistula First
• Davita