Dialysis access (DA) is a pathway that is constructed underneath your skin to provide entry to your bloodstream. The purpose is to recycle the blood through a filtration device known as a hemodialyzer. Often used to treat patients when their kidneys fail, the method focuses upon arteries and large veins that can provide sufficient flow.
Today’s article will provide an overview of dialysis access (sometimes called hemodialysis). We’ll explain the construction of fistulas and grafts beneath the skin as well as eligibility requirements and preparation before the procedure. Finally, we’ll describe what patients can expect after the procedure.
Fistulas And Grafts
Vascular surgeons will often create a portal by connecting one of your arteries and a vein. This portal is called an arteriovenous fistula. It is entirely natural because there are no artificial materials used. By contrast, an arteriovenous graft is a plastic tube that is inserted to provide the connection. Over time, the flow of blood increases, stretching and strengthening the vein. This maturation is important because hemodialysis requires a minimum flow rate in order to be successful.
Fistulas usually require up to six months to fully mature while the maturation period for a graft can be as little as a few weeks. That said, vascular surgeons normally prefer fistulas to grafts. The absence of foreign materials under the skin makes infection less likely.
Eligibility And Preparation
As noted, kidney failure requires dialysis access. The only question is which procedure to use in order to remove and return blood to the body. While vascular surgeons prefer constructing a fistula, there are potential hurdles. For example, if a patient’s veins are too small or there is persistent scarring from frequent needle insertions, a graft may be more effective. Similarly, if there are blockages in the target artery, inserting a plastic tube may be necessary.
Before the procedure, your surgeon will likely ask whether you suffer from any arterial diseases or circulation problems. The reason is because these types of issues can reduce the blood flow in certain areas of your body. Your surgeon may also perform an ultrasound to identify the size of your veins in a target area (i.e. arms or legs). Finally, you’ll be instructed to fast for at least eight hours leading up to the procedure.
After The Procedure
Once dialysis access has been completed, you’ll need to keep the entry point elevated in order to prevent swelling. Because there is likely to be some discomfort, your doctor may suggest taking medicine in order to relieve the pain. Also, during the maturation period, your surgeon might recommend light exercises to make the connection between your vein and artery more durable.
Ideally, the portal that connects your artery to your vein will last for years. In the case of an arteriovenous fistula, patients can expect the passageway to last for up to seven years. Grafts may be short-lived due to their susceptibility to infection. If they become infected, they must be removed.
Dialysis access is a minor surgical procedure. However, you should speak with a vascular specialist to determine the appropriate strategy given your needs.