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Renal Replacement Therapies

Access

You can be attached to a dialysis machine with a tube which provides access to your bloodstream. There are three types of blood accesses: arteriorvenous fistula, internal graft and central venous catheters.

Arteriovenuous fistula

The arteriorvenous fistula provides blood access by surgically connecting an artery and a vein together. This is usually performed in your non-dominant hand. When the artery and vein are joined together, the blood from the artery flows into the vein. This allows for the vein to become much larger and stronger.  The vein becomes stronger to support the vein from repeated needle insertions. The arteriovenous fistula is the safest access site because of its smaller chance of infection and clotting

Arteriovenous fistulas can be used after about three months. To help the fistula properly develop and form, special exercises like squeezing a tennis ball can be done to strengthen the vein.

Arteriovenous graft

Arteriorvenous (AV) grafts is another option for providing access to your bloodstream. It is commonly done if your blood vessels are too small or not available for a fistula. An arteriovenous graft uses a looped plastic tube to connect your artery to your vein. The graft then becomes the access site for inserting needles for hemodialysis. The AV graft can be used two or three weeks after surgery. An AV graft is more likely than a fistula to become infected or form clots. However, if it is taken care of properly it can last for several years.

 

Central venous catheter

If a patient’s kidney disease has progressively worsened, treatment may be needed as soon as possible. During these situations, a central venous catheter or “central venous line” is best option. A central venous catheter is inserted into a vein in the neck, chest, or leg (near the groin) for a short period of time. The most commonly used veins are the jugular vein and the subclavian vein. The jugular vein is located on the side of the neck and the subclavian vein is found under the collarbone.

The catheter is made of two soft tubes that are joined together side by side. The two tubes that sit outside the body form one tube that is inserted in the vein for access to the blood stream. One tube is used to carry blood to the dialyzer and the other for carry blood from the dialyzer to the body.

The central venous line is left in place until a permanent access site such as the fistula graft, of peritoneal dialysis catheter is ready.