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In-Center HemodialysisIn-Center Hemodialysis
Hemodialysis Access: Your Lifeline for Treatment
During hemodialysis, your access site is your lifeline—it allows blood to safely leave your body, travel to the artificial kidney or dialyzer and safely return to your body. You'll want to make sure you have the safest, most effective type of access for you—and that you care for it properly.
There are 3 types of dialysis access sites: fistula, graft or catheter. Depending on your health, the strength of your veins and other factors, you and your doctor can decide which type is best for you.
Be aware that you will need to schedule your surgery for fistulas or grafts in advance of your dialysis treatments. These are considered minor surgeries and are usually done on an outpatient basis. If you have already started your treatment and have a catheter, it is still important to have surgery for a fistula or graft. Catheters are generally not recommended for the long-term because they provide a slower rate of blood flow and have a higher risk of infection and blood clots.
3 types of dialysis access sites
- A fistula is considered the best choice for hemodialysis. It is made with your own blood vessels, provides optimal blood flow and has the lowest chance of infection.
- To create a fistula, a surgeon connects one of your arteries to a vein under the skin of your upper or lower arm.
- If possible, the fistula access should be placed at least 2 to 3 months before you begin dialysis to allow time for it to develop and mature. However, your doctor will recommend appropriate timing.
- If you are unable to have surgery for a fistula before you begin treatment, it is still possible to do so after your treatment has begun. It is especially recommended if you have had to opt for a temporary catheter.
- During treatment, a nurse places 2 needles into the fistula. These needles are connected to tubing that lead to and from the dialysis machine. During dialysis, your blood flows out of your body through one needle that is connected to your artery and into the dialysis machine. After your blood is filtered, it returns to your body through the other needle, which is connected to your vein.
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CHOOSE THE RIGHT DIALYSIS TREATMENT FOR YOU
Whether you’re getting ready for dialysis or want to switch to a different type, our Treatment Decision Guide can help you decide what treatment option is best for you.
- A surgeon connects your artery to a piece of soft tubing that acts like a vein. It’s placed under the skin of your upper or lower arm.
- During treatment, a nurse places 2 needles into the graft. These needles are connected to the tubing that lead to and from the dialysis machine. During dialysis, your blood flows out of your body through one needle connected to your artery and into the dialysis machine. After your blood is filtered, it returns to your body through the other needle, which is connected to your vein.
- Most catheters are temporary and used only until a fistula or graft is ready.
- If your blood vessels are not strong enough for a fistula or graft, you may be a candidate for a catheter.
- Catheter access is inserted by a kidney doctor (nephrologist) or surgeon.
- A long Y-shaped tube (catheter) is placed in your neck, chest or groin and is connected to a central vein. The other end of the tubing exits your skin and attaches to the tubing on the dialysis machine.
- A catheter can be used immediately after placement.
- Since catheters have a higher risk of clotting and infection and provide a slower blood-flow rate, they are not recommended for the long-term. If you have a catheter, talk to your doctor to see if you are a candidate for a fistula or graft.
There are 3 simple practices to adopt:
- Practice good hygiene—always wash your hands before touching your access, and make sure others do too. Before using your access, be sure to clean your site, arms and hands.
- Protect your access site—wear loose clothing or jewelry to prevent pressure on your access site. Use your other arm to carry heavy objects so you don't strain the access area.
- Check your access site—carefully inspect the area around your access site for any sign of infection, including redness, swelling, drainage or irritation. For a fistula or graft, check your access site for good blood flow.
Questions? Don't wait. Contact your nurse immediately if you notice any of the signs of infection described above.