Understanding Your Dialysis Access Options

Hemodialysis, known simply as dialysis, is an essential, long-term treatment for kidney failure that works to replace lost kidney function. Before dialysis can begin, it’s necessary to establish an access site — or a long-lasting vascular opening to facilitate a seamless treatment process. 

From six offices in Kalamazoo, Allegan, Battle Creek, Coldwater, Sturgis, and Three Rivers, Michigan, our expert team at Advanced Vascular Surgery offers a full scope of dialysis access services, from site creation to routine maintenance. 

Here, our board-certified specialists discuss the three main access options for dialysis. 

Understanding dialysis access

Dialysis access, also called vascular access, is a sustained, long-term opening created in a blood vessel to facilitate hemodialysis. Dialysis uses a special machine called a dialyzer to clean your blood, effectively standing in for a function that unhealthy kidneys can no longer perform adequately. 

Two separate tubes (outflow and inflow) are connected to the access site during dialysis. A few ounces at a time, your blood flows out of the access site and into the dialyzer, where it travels through thin fibers that filter out waste and excess fluids. The clean blood then flows back into your body through the access site via the inflow tube.

Three main dialysis access types

Unless you need to start dialysis right away with a temporary portal, your access site should be in place and fully healed for several weeks in advance of your first scheduled treatment. 

There are three main types of vascular access sites used to facilitate dialysis; two are intended for long-term use, and one is designed for immediate, short-term use. 

AV fistula access site

An AV fistula involves taking part of a vein from an arm or leg and creating a dialysis access site by grafting it onto an artery in your non-dominant arm (or in some cases, an artery in a leg).  

Also called a dialysis fistula, this technique results in an increased blood flow in the sewn-in vein, causing it to enlarge and become stronger and thicker, much like an artery. 

Advantages

An AV fistula is considered the “gold standard” long-term dialysis access opening because it carries a low infection risk and is less prone to clotting. It makes needle insertion easy during dialysis treatment. It’s durable and can function well for many years before a new access site is needed. 

Drawbacks

An AV fistula can take 1-4 months to heal before it’s ready for use, making it a poor option for those who require treatment sooner. In such cases, however, it’s often possible to create and use a temporary access site while waiting for a simultaneously created AV fistula site to heal and mature.

AV graft access site

An AV graft is a type of dialysis access that uses a soft tube (prosthetic graft) to join an artery and a vein in your non-dominant arm. If your blood vessels aren’t strong enough or big enough for AV fistula surgery, an AV graft is the next best long-term access option. 

Advantages

An AV graft heals more quickly than an AV fistula and can be ready for use in as little as 3-4 weeks. The graft is easy to implant and can be done on an outpatient basis. During a dialysis session, needles are inserted into the graft — rather than into your arm.  

Drawbacks

Because it involves a prosthetic, an AV graft is more vulnerable to infection and clotting than an AV fistula. It doesn’t last as long as an AV fistula, either. 

Venous catheter access site 

A central venous catheter is a soft tube that’s placed in a large vein, usually in the neck. This type of dialysis access site, which doesn’t come with a period of healing, is intended for short-term use because the risk of infection is high. 

Advantages

A venous catheter is often used when kidney disease has progressed quickly and a patient can’t wait for the creation and healing of an AV fistula or graft before starting dialysis. Its main advantages are its quick, easy placement and immediate access — it can be used right away. 

Drawbacks

Venous catheter drawbacks include an increased risk of infection, clotting, and central vein damage; it may also increase the length of your dialysis treatment time. 

Expert dialysis access creation 

If you’re about to start dialysis, you need an access site that matches your needs — and we’re here to help. Call or click online to schedule a visit at Advanced Vascular Surgery in Kalamazoo, Allegan, Battle Creek, Coldwater, Sturgis, or Three Rivers, Michigan, today.