Anatomy of a Dialysis Clinic: Accesses

Every realm of medicine has their own “medspeak“.

In dialysis the most common word you are going to hear is “Access”, the nurse will ask about your access, the Doctors will refer you to surgeons for your access, and the Surgeon is going to “place” an access somewhere in your body.

So what are these “accesses”?

Well in hemodialysis you really have three choices:

-Catheter
-AV fistula
-AV graft

AV stands for “Arteriovenous” which we will get into later.

A catheter is usually used for first time dialysis patients or when their AV access fail.  It is placed either in their jugular vein or in the Superior Vena Cava (SVC) which leads directly towards the heart. 

A dialysis catheter has a cuff which prevents it from slipping out when lightly tugged or pulled from clothing or daily life.  This cuff us just under the skin and is also a good protection against bacteria that can so easily travel through the tunneled catheter site.

That is why Doctors and Surgeons are so intent on getting another form of access such as an AV fistula or AV graft.

There is a program called Fistula First.  It goes “fistula first, graft second, catheter last”.

A fistula is made up of your very own vein and artery tied in an anastomosis that creates a greater amount of blood flow through the fistula thus creating a easily accessible access into the blood stream, sustaining life through dialysis treatments.

They are usually placed in the upper arm or lower arm of the non-dominate arm, although sometimes the dominate arm has to be used. 

A lower arm fistula looks like this:

Photo Credit.

A upper arm fistula looks like this:

Photo Credit.

The difference between the two isn’t noteworthy, although I have noticed from the vascular surgeons in our area that more and more upper arm fistulas (UAF) are coming through.

The reason it is considered the best course of action is because it is a biological part of the body, the risk of infection is lower, the risk of clotting is lower and all around the body has an easier time healing and accepting the alterations of the vein and artery.  They also statistically last longer then AV grafts and catheters.

An AV graft is made up of a gortex material or that of bovine, both are considered a graft since both are not found in the patients body. 

Again the synthetic material is tied into a artery and a vein.  The good thing about a graft is that it can be used three to six weeks after surgery whereas a fistula needs a few more weeks to mature.

The bad things about grafts are possible increase of infection, “one-site-itis” , and they statistically do not last as long as fistulas, usually between three to seven years, although there are exceptions to the rules.

There are of course variations to every access I have mentioned, that part of the deal is up the Surgeon and Nephrologist to decide what is best for that particular patient.

Remember…

“Fistula first, graft second, catheter last”

 

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~ by Kim on June 25, 2008.

2 Responses to “Anatomy of a Dialysis Clinic: Accesses”

  1. I was fortunate, because I had an upper arm fistula placed, and didn’t need to use it for 2 years.

    My sister had several attempts at fistulas, and ended up with a graft. The graft is always clotting; she goes in at least every 2 months to get the clots removed.

    My fistula, though, hasn’t been without problems. I’ve had 3 fistulaplasties; I had a stent placed at the shoulder area, 4-5 areas of stenosis ballooned each time, and need another stent placed in the near future. Overall, though, I’d much rather have a fistula.

  2. This post was extremely helpful! I just started doing dialysis transfers at the beginning of this month, and I had no idea about any of this (except for that catheters got infected more easily–I learned that a doctor’s appointment transfer I did!).
    I’m really glad to learn some more about it, since being and feeling ignorant is not something I enjoy, haha!
    Thanks so much 🙂

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