Dialysis Access for End Stage Renal Disease
Understanding Dialysis Access for Patients with End Stage Renal Disease
End Stage Renal Disease is the final stage of chronic kidney disease. End Stage Renal Disease patients need dialysis up to three times a week to replace the function of the failing kidneys. Dialysis requires a reliable access point to the bloodstream, known as dialysis access. Glendale Vascular surgeons establish dialysis access points based on each patient’s specific medical needs, using an arteriovenous fistula, graft, or catheter.
What is End Stage Renal Disease?
End Stage Renal Disease (ESRD) is the final stage of chronic kidney disease, at this stage, the kidneys have lost nearly all their ability to filter waste, excess fluids and toxins from the bloodstream. As kidney function declines, the waste, fluids and toxins buildup in the body, leading to serious health issues. ESRD is often caused by long-term conditions such as diabetes, high blood pressure, or chronic kidney infections that progressively damage kidney tissue. At this advanced stage, treatment options are limited to dialysis or kidney transplant to perform the vital functions the current kidneys can no longer handle. Dialysis serves as a life-sustaining treatment that helps manage ESRD by taking over the role of the kidneys, filtering waste and balancing fluids to maintain essential body functions. Dialysis is often a stop-gap for kidney transplant and sustains the body while the patient waits for an organ match.
What is Dialysis Access and Why is It Needed?
Dialysis access is a surgically created entry point into the bloodstream for efficient and reliable dialysis treatment in patients with ESRD. The access point enables blood flow to run through the dialysis machine and back into the body. Depending on the patient’s needs and length of care our vascular surgeons will determine the most suitable access type. Options include, arteriovenous fistula, AV graft, or a central venous catheter. An arteriovenous fistula or graft is often preferred for long-term dialysis care because they are durable and reduce the risk of infection, while a central venous catheter may be recommended for short-term use. Choosing the right access type ensures safe and effective dialysis connection that will be used many times over the course of the patients dialysis treatment.
Types of Dialysis Access
Several types of access are available for dialysis patients. Access methods are chosen based on the patient’s condition and long-term needs:
- Arteriovenous (AV) Fistula: An AV fistula is created by surgically connecting an artery and vein, usually in the forearm. This connection strengthens the vein, allowing it to handle the higher blood flow necessary for dialysis. AV fistulas are the preferred option because they are durable and provide strong blood flow, but they require a few weeks to months to mature before they can be used
- Arteriovenous (AV) Graft: For patients with smaller or weaker veins, an AV graft is used to connect an artery and vein. The artery and vein connection is made with a synthetic tube or graft. AV grafts are quicker to use than fistulas but may require more maintenance due to a higher risk of clotting and infection.
- Central Venous Catheter (CVC): A CVC is a temporary option where a catheter is inserted into a large vein, often in the neck or chest. This access type is used for immediate dialysis needs or when other access types are not feasible. CVCs are generally a short-term solution due to the increased risk of infection and blood clot formation to the patient with this dialysis access type.
Different dialysis access types have specific benefits and considerations. The vascular team at Glendale Vascular will discuss the options with you and help you make the best decision for your ESRD case.Contact Glendale Vascular today for immediate or future dialysis access needs.
Dialysis Access Procedure Overview
The procedure for creating a dialysis access point is a minor vascular surgery performed by our board-certified vascular surgeons at Glendale Vascular. Here is a general overview of the procedure to create a dialysis access point depending on the dialysis access point method:
- Preparation: The patient is given local anesthesia. A small incision is made in the area where the access will be made (typically in the arm for AV fistulas and grafts, or near the neck for CVCs).
- Access Creation:
- For an AV fistula, the surgeon connects a vein to a nearby artery to strengthen the vein and increase blood flow.
- For an AV graft, a synthetic tube is used to connect the artery and vein connection, creating a durable loop for blood flow under the skin.
- For CVC access, a catheter is inserted into a large vein, and the catheter tubing is tunneled under the skin to reduce infection risk.
- Post-Procedure: Patients are typically monitored briefly after surgery. AV fistulas and grafts will require a maturation period before the access point is ready for regular dialysis, while CVCs can be used immediately if necessary.
The dialysis access procedure is relatively quick, most patients can return home within the same day. The surgeons at Glendale Vascular will provide detailed instructions for caring for the access site and ensuring it functions properly long-term.
Daily Maintenance and Care for Dialysis Access
Dialysis access points require daily care to maintain it’s effective use. Caring for the dialysis access point is crucial to preventing complications and ensure its durability for the long-term:
- Daily Cleaning: Clean the access area with mild soap and water daily. Avoid harsh chemicals that may irritate the skin.
- Monitoring for Signs of Infection: Check the access site for redness, warmth, swelling, or discharge, early recognition of signs of infection is vital for maintaining a health dialysis access point that is used multiple times a week. If any of these signs occur, notify your dialysis provider or Glendale Vascular promptly.
- Avoid Heavy Lifting and Pressure: Refrain from lifting heavy objects with the arm where the access is located and avoid any pressure that could restrict blood flow to the site of the access.
- Check Blood Flow: The medical team at Glendale Vascular will show you how to feel for the “thrill” (a buzzing sensation over the access site), this sensation indicates healthy blood flow. Report any changes in this sensation to our medical team.
Routine check-ups will also allow your doctor to assess the health of the access point to address any issues before they impact the dialysis effectiveness and access connection.
Dialysis Access Procedure and PostOp Risks
Dialysis access procedures are minor vascular surgeries that are relatively safe and quick. Each access method carries certain ongoing risks however:
- Infection: Any type of dialysis access can become infected. AV grafts and CVCs are particularly susceptible, these infections may require antibiotics or removal of the access method and treatment of the infection site.
- Clotting: Blood clots can develop within the access, especially in grafts or catheters. This can reduce blood flow and may require intervention.
- Access Failure: AV fistulas or grafts can sometimes fail to mature or weaken over time, leading to poor blood flow and necessitating the creation of a new dialysis access point.
Contact Glendale Vascular for Dialysis Access Surgery for ESRD Patients
If you’re living with End Stage Renal Disease and require dialysis access or ongoing dialysis management, Glendale Vascular provides comprehensive surgical care for your needs. Our experienced team offers skilled dialysis access creation, ongoing support and guidance on maintaining your access site for long-term use. Contact Glendale Vascular today to schedule a consultation and learn how we can support your dialysis care and overall health.