What is hemodialysis vascular access?

Hemodialysis, or dialysis, is the use of a machine to remove wastes from your blood. You need it if your kidneys are not able to remove wastes on their own. A dialysis access is the place in your arm, or sometimes in your leg, where a doctor creates a blood vessel that carries a large flow of blood.

Your doctor creates an access during a minor surgery. You need to take care of your access to keep it working and to prevent infection.

When you have dialysis, two needles are placed in this blood vessel and are connected to the dialysis machine. Your blood flows out of one needle and into the machine to be cleaned. Then your cleaned blood flows back into your body through the other needle. Sometimes a doctor makes a short-term access through a tube, called a catheter, placed in your neck, upper chest, or groin.

There are a few ways to access the veins for hemodialysis.

Permanent access

There are two permanent access types:

• An arteriovenous (AV) graft is made by inserting a small tube between an artery and a vein. It's usually in the upper arm or forearm. A graft is a good choice if you have small veins or other problems. It can sometimes be used as soon as 1 week after placement. But a graft may not last as long as a fistula. It's more likely to get infected or to get narrow and cause blood clots.
• An arteriovenous (AV) fistula is made by directly connecting an artery to a vein. It's usually in the upper arm or forearm. A fistula tends to last longer than a graft, and it's less likely to cause blood clots and get infected. You have to plan ahead for a fistula. That's because it needs at least several months to heal after placement. But a fistula is the most dependable access type.

Short-term dialysis access

If you need to start dialysis right away, your doctor may place a tube in a vein. It's usually in your neck or chest. This is called a central vascular access device. You can use it while your permanent access heals.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Do not lie on or sleep on the arm with the access.
• Avoid activities such as washing windows or gardening that put stress on the arm with the access.
• You may use your arm, but do not lift anything that weighs more than about 15 pounds. This may include a child, heavy grocery bags, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• You can shower, but keep the access dry for the first 2 days. Cover the area with a plastic bag to keep it dry.
• Do not soak or scrub the incision until it has healed.
• Wear an arm guard to protect the area if you play sports or work with your arms.
• You may drive when your doctor says it is okay. This is usually in 1 to 2 days.
• Most people are able to return to work about 1 or 2 days after surgery.

Diet

• Follow an eating plan that is good for your kidneys. A registered dietitian can help you make a meal plan that is right for you. You may need to limit protein, salt, fluids, and certain foods.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take acetaminophen (Tylenol). Do not take ibuprofen (Advil, Motrin) or naproxen (Aleve), or similar medicines, unless your doctor tells you to. They may make chronic kidney disease worse.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• Keep the area dry for 2 days. After 2 days, wash the area with soap and water every day, and always before dialysis.
• Do not soak or scrub the incision until it has healed.
• If you have a bandage, change it every day or as your doctor recommends. Your doctor will tell you when you can remove it.

Exercise

• Squeeze a soft ball or other object as your doctor tells you. This will help blood flow through the access and help prevent blood clots.

Elevation

• Prop up the sore arm on a pillow anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.

Other instructions

• Every day, check your access for a pulse or thrill in the fistula or graft area. A thrill is a vibration. To feel a pulse or thrill, place the first two fingers of your hand over the access.
• Do not bump your arm.
• Do not wear tight clothing, jewelry, or anything else that may squeeze the access.
• Use your other arm to have blood drawn or blood pressure taken.
• Do not put cream or lotion on or near the access.
• Make sure all doctors you deal with know that you have a vascular access.

Any type of dialysis access has some risk of failure. So it's important to always protect your access and be alert for signs of clotting or infection.

• Call your doctor right away about any signs of trouble.
• Make a habit of talking with your dialysis nurses and doctor about how well your access is doing.

If your dialysis access fails, it will be repaired or replaced. You and your doctor will choose your next best option for dialysis access. To keep up a regular dialysis schedule, you need a sturdy dialysis access where blood can flow in and out of the body.

A hemodialysis access is a site on your body where dialysis needles can be placed. It's most often made by joining a vein and an artery, usually in an arm. Your blood flows through the needles and into tubes that go to and from a dialysis machine to remove wastes from your blood.