Dialysis Access

Dialysis Access Specialists
Dialysis is a treatment used to help patients with end-stage kidney failure. The treatment cleans and filters the blood when the kidneys can no longer do the job. Before dialysis can begin, it’s necessary to establish dialysis access, which is a vascular opening that allows the high-rate blood flow that the treatment requires. Dr. David L. Rollins, Dr. Vikram K. Rao, and the vascular care team at Northeast Ohio Vascular Associates (NEOVA) are seasoned experts in providing dialysis access. From their state-of-the-art medical office in Willoughby, Ohio, they serve patients from communities in the Cleveland area.

Dialysis Access Q & A

Northeast Ohio Vascular Associates

What is vascular access?

The blood flow must move rapidly in order to perform dialysis. Vascular access is the process of placing either a catheter (tube) into a large vein, hooking an artery or vein together (fistula), or placing a graft between an artery or vein.

How does an AV fistula work?

An AV fistula, also called a dialysis fistula, involves taking part of a vein from your arm or leg and sewing it into a nearby artery, which causes the sewn-in vein to enlarge and become thicker, much like an artery.

Fistula surgery allows needles to be easily inserted into the vein for dialysis treatment. Although it’s considered the best option because it has the lowest risk of infection, an AV fistula can take anywhere from 1-4 months to heal before it’s ready for use.

How does an AV graft work?

If your blood vessels aren’t adequate for a fistula, the team at NEOVA may use a soft plastic tube to join an artery and a vein under your skin. This is called prosthetic graft surgery. A dialysis graft is the best option for patients whose veins are too small for fistula surgery. During dialysis, the needle is inserted directly into the graft. Modern dialysis grafts may be used in as short a time as a few hours, they may also have a higher infections rates than dialysis fistulas which are formed from natural tissue.

How does a central venous catheter work?

A dialysis catheter is a soft plastic tube that’s tunneled under your skin and placed in a vein located in either your neck, chest, or groin. From there, the catheter continues into a central vein that leads to your heart. Although a central venous catheter can be used immediately, it’s intended for short-term use — a few weeks or months — because the risk of infection is relatively high.

Tunneled dialysis catheters can be a long-term solution for patients whose blood vessels aren’t strong enough for a fistula or a graft. In such cases, a permanent catheter using permacath placement surgery, may be placed in the chest.

What problems should I watch out for?

Dialysis fistula bleeding and infection are the most common complications of vascular access surgery.  Should any excess bleeding or prolonged bleeding after dialysis procedures occur, it’s likely that there’s a blockage in the vein further up which needs to be fixed quickly. If the fistula or graft stops working, the thrill or tingling sensation you feel when you put your fingers over the fistula or graft will be gone. Blood clots, which will require treatment by vascular surgery, may have formed. Feeling a pulse instead of a thrill in a fistula or graft also indicates that a blockage that needs surgical attention may be present. Grafts and catheters are more prone to thrombosis and blood clots than fistulas.

Infection causes swelling, soreness at the location where the catheter exits the skin, pain and redness at the needle puncture site, or chills and fever. Dialysis fistulas are much less frequently infected.

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