If you have been diagnosed with kidney disease you may eventually need to make a decision about starting dialysis. In order for dialysis to occur there needs to be a point of connection between the dialysis machine and your body. This is what will be referred to as your dialysis access. It is important that you are aware of the different types of dialysis access.
Placement of your dialysis access is ideal when it happens BEFORE you need to start dialysis. Your nephrologist will help you determine the best timing for this.
Dialysis Access is necessary for all patients prior to the initiation of dialysis. |
There are two types of dialysis; both types are associated with specific types of dialysis access:
- Hemodialysis which can be done either at home or in the hospital/kidney care center, and
- Peritoneal dialysis which is done at home.
Associated dialysis accesses:
Hemodialysis
This type of dialysis requires easy access to your blood stream. There are three types of dialysis access associated with hemodialysis.
- Fistula
A surgeon creates an AV fistula by connecting an artery directly to a vein, frequently in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis treatments easier. For the surgery, you’ll be given a local anesthetic *. In most cases, the procedure can be performed on an outpatient basis.
(*At LHSC IV sedation is given as well)
This type of hemodialysis access has the greatest number of advantages when compared to the graft and permcatheter.
- Graft
If you have small veins that won’t develop properly into a fistula, you can get a vascular access that connects an artery to a vein using a synthetic tube, or graft, implanted under the skin in your arm. The graft becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft doesn’t need to develop as a fistula does, so it can be used sooner after placement, often within 2 or 3 weeks.
Compared with properly formed fistulas, grafts tend to have more problems with clotting and infection and need replacement sooner. However, a well-cared-for graft can last several years.
This type of hemodialysis access has fewer advantages than using a fistula as dialysis access, but more advantages than a permcatheter.
- Permcatheter
If your kidney disease has progressed quickly, you may not have time to get a permanent vascular access before you start hemodialysis treatments. You may need to use a venous catheter as a temporary access.
A catheter is a tube inserted into a vein in your neck, chest, or leg near the groin. It has two chambers to allow a two-way flow of blood. Once a catheter is placed, needle insertion is not necessary.
Catheters are not ideal for permanent dialysis access. They can clog, become infected, and cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, a catheter will work for several weeks or months while your permanent dialysis access develops.
This type of hemodialysis access has fewer advantages than using a fistula or a graft, but will used as temporary dialysis access if you need to start dialysis urgently.
It is not uncommon for dialysis patients to have experience with more than one type of dialysis access. Eg: Patients use a permcatheter for dialysis access as a bridge, until a permanent dialysis access is ready to be used ie: a fistula or graft.
All three dialysis accesses provide access to your blood stream for dialysis to occur, and all have advantages and disadvantages depending on your particular situation.
Please view the following link, it is an excellent resource that will provide you with information on the types of hemodialysis access, clearly outlining the advantages and disadvantages of each.
The choice regarding dialysis access is a very important decision because it is your lifeline. Your renal team will discuss dialysis access with you at your nephrology appointments and help you to make the best choice that is appropriate for you.
We welcome your questions at your next nephrology appointment or in the dialysis unit so we can start to get a plan in place for you!
Refer to the Save My Veins Fact Sheets and Wallet Cards available on the Ontario Renal Network Website
Peritoneal Dialysis
This type of dialysis requires access to your abdominal cavity and there is only one type of dialysis access associated with peritoneal dialysis.
Peritoneal dialysis catheter
Peritoneal dialysis requires access to the peritoneal cavity. During a minor operation, performed using a local or a general anesthetic, the doctor inserts a soft plastic tube into the abdomen. This tube is called a peritoneal dialysis catheter (PD catheter). It acts as a permanent pathway into the peritoneal cavity.
"My PD Catheter Insertion" YouTube video
The PD catheter is about 30 cm (12 inches) long, and about as wide as a pencil. About 15 cm (6 inches) of the tube remains outside your body, allowing the disposable dialysis bags to be attached. The place where the catheter comes out of the body is called the exit site.
The catheter is usually placed just below and slightly to the side of the belly button. Your doctor or nurse will determine with you the exact location for the exit site so that the catheter can be comfortably and easily hidden under clothing.
"Adjusting to the PD Catheter" YouTube video
The catheter exit site is usually covered with a dressing and the catheter is taped to the skin to avoid pulling on the exit site.
Your peritoneal-dialysis nurse will teach you a simple routine for cleaning and looking after the exit site. Proper care of the exit site is important in order to avoid infection.
We welcome your questions at your next nephrology appointment or in the dialysis unit so we can start to get a plan in place for you!
