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Article title: Vascular Access for Hemodialysis: NIDDK
NIDDK Home : Health Information : Kidney Diseases : Kidney Failure
IntroductionIf you will be starting hemodialysis treatments in the next several months, you will need to work with your health care team to learn how the treatments work and what you can do to get the most from them. One important step before starting regular hemodialysis sessions is preparing a vascular access, which is the site on your body where blood will be removed and returned during dialysis. A vascular access should be prepared weeks or months before you start dialysis. It will allow easier and more efficient removal and replacement of your blood with fewer complications. There are several kinds of vascular accesses.
The arteriovenous (AV) fistula is the best approach if your veins are large enough and there is time to prepare it. Otherwise, a graft or a catheter may be needed.
A surgeon creates an AV fistula by connecting an artery directly to a vein, usually 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 easier. For the surgery, you'll be given a local anesthetic. In most cases, the procedure can be performed on an outpatient basis.
The tube becomes an artificial vein that can be used repeatedly for needle placement. 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 fistulas, grafts tend to have more problems with infection or clotting and need replacement sooner, but a well-cared-for graft can last for several years.
A catheter is a tube inserted into a vein in either your neck, chest, or leg near the groin. It has two chambers to allow two-way flow of blood. Once a catheter is placed, needle insertion is not necessary.
Catheters are not ideal for permanent access. They can clog, become infected, or cause narrowed veins. But if you need to start hemodialysis immediately, a catheter will suffice for several weeks or months while your permanent access develops.
For some patients, fistula or graft surgery is not successful, and long-term catheter access must be used. Catheters that will be needed for more than about 3 weeks are designed to be tunneled under the skin to increase comfort and reduce complications.
Catheter for temporary access.
Some people prefer to insert their own needles. You'll need training for this to learn how to prevent infection and protect your vascular access. You may also learn a "ladder" strategy for needle placement in which you "climb" up the entire length of the fistula session by session so you won't weaken an area with a grouping of needle sticks. An alternative approach is the "buttonhole" strategy in which you use a limited number of sites but insert the needle precisely into the same hole made by the previous needle stick. Whether you insert your own needles or not, you should know about these techniques so you can understand and ask questions about your treatments.
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About the Kidney Failure SeriesThe NIDDK Kidney Failure Series includes six booklets and seven fact sheets that can help you learn more about treatment methods for kidney failure, complications of dialysis, financial help for the treatment of kidney failure, and eating right on hemodialysis. For free single printed copies of this series, please contact the National Kidney and Urologic Diseases Information Clearinghouse.
National Kidney and Urologic Diseases Information Clearinghouse
3 Information WayThe National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1987, the clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.
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NIH Publication No. 01-4554
Posted: May 2001
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