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Hemodialysis Access Creation

Hemodialysis has proven itself to be a life-saving technology. Despite the many advantages it offers, it is still associated with potential difficulties and complications. The majority of complications from hemodialysis therapy are associated with “hemodialysis access” which represents the connection between the hemodialysis machine and your body. With the help of your nephrologist, we will help you choose and create the dialysis access that is most appropriate for your situation.

Tunneled Catheters

A tunneled catheter is a plastic tube that is placed directly into a neck or groin vein. The tip of the catheter is positioned just inside the heart while the other end of the catheter is “tunneled” under your skin to a convenient location on your chest or your thigh. Tunneled catheters are used in situations when access is needed soon as they can be used immediately after placement. Unfortunately, catheters need replacement more often than any other method of hemodialysis access and are frequently the cause of blood stream infections.

Fistula Creation

Fistulas are the most desired method of hemodialysis access as they have the lowest rate of complication and tend to be the most durable. When a fistula is made, there is a connection created between one artery and one vein in the arm. With this configuration, the artery will cause the vein to grow in size and strength. Once the fistula is well grown, needles can be stuck in the vein (“the fistula”) and dialysis can be performed through that connection. It is rare for fistulas to be the cause of bloodstream infections. Fistula creation does require a small surgical incision. The biggest obstacles for fistula creation are the need for large and healthy blood vessels and the need for the fistula to “mature” for several months prior to being used for dialysis. In many cases, more than one procedure may be needed to get the fistula ready for cannulation.

Dialysis Graft

Dialysis grafts are very similar to fistulas. They are synthetic tubes normally placed in the arm or leg and they represent another means of connection between an artery and a vein. Grafts are used when they are no healthy veins to utilize for fistula creation. Because they are made of man-made material, they are more prone to infection than a fistula however they are usually ready to be used more quickly after surgery than a fistula.

Hybrid Grafts, HeRO Grafts, and Acuseal Grafts

For some patients will limited hemodialysis access options or complicated anatomy, a special device may be needed for hemodialysis access creation. Some of these devices help us utilize the access quicker while other devices help us manage difficult vascular anatomy situations. These devices are more complicated and we can describe them further for you in person if needed. Most importantly, know that we have many tools that we can use to help you maintain healthy hemodialysis access.