What is hemodialysis vascular access?

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.

The vascular access is where the needles are put that draw the blood from your body and send it through tubes to the dialysis machine. This access is also used to return the clean blood that is sent back into your body. There are two basic types of permanent vascular access:

AV fistula.

To make a fistula, your doctor will connect an artery to a vein in your arm. After the fistula heals, the dialysis needles can be put into it. Fistulas tend to be stronger and less likely to get infected than grafts. But they need to be prepared at least several months ahead of time.

AV graft.

To make a graft, your doctor will put a tube under the skin in your arm. The tube, or graft, connects an artery and a vein. The dialysis needles can then be put into the graft for dialysis. A graft is a good choice if you have small veins or other problems. A graft can sometimes be used as soon as 1 to 3 weeks after placement.

You will be asleep or get medicine to feel relaxed during the surgery. You will not feel pain. Your doctor will make a cut (incision) on the arm you use the least. If you are right-handed, the fistula or graft will probably be put in your left arm. If you are left-handed, it will probably be put in your right arm. Your doctor will close the incision with stitches. The incision will leave a scar that fades with time.

If you need to start hemodialysis right away, your doctor may place a tube in a vein in your neck, chest, or arm. This is called a central vascular access device (CVAD). It can be used while your permanent access heals. CVADs have more problems than an AV fistula or AV graft, so they aren't the best choice for permanent access.

If you get an AV fistula, you will probably go home the same day as the surgery. If you get an AV graft, you may spend 1 night at the hospital. You will probably need to take 1 or 2 days off from work.

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.

• After your doctor creates an access, keep it dry for at least 2 days.
• Squeeze a soft ball or other object as instructed after the access is placed. This will help blood flow through the access and help prevent blood clots.
• After you have dialysis, check to see if the access bleeds or swells. Let your doctor know if your arm bleeds or swells.
• Do not lift anything heavy with the arm that has the access.
• Do not bump your arm.
• Don't wear tight clothing or jewelry over the access.
• Don't sleep with your access arm under your body.
• Have blood drawn or blood pressure taken from your other arm.
• Keep the access clean and dry.
• Don't put cream or lotion on or near the access.