Hemodialysis Access
What is hemodialysis access?
Patients with severe chronic kidney disease may eventually reach a point where their kidneys are no longer capable of clearing toxins and metabolites from the body. As a result, these substances can build up in the patient’s blood stream and cause severe symptoms and at times, death. At this point, nephrologists begin to recommend dialysis. Dialysis serves the function of the kidneys when they are no longer capable of meeting the body’s demands by filtering the patient’s blood.
To start dialysis, an access point must be established. This can be achieved in three ways: placement of a catheter in the neck or chest, placement of an upper or lower extremity access point, or placement of a catheter in the abdomen. For hemodialysis, the two options are a catheter in the neck or chest or placement of permanent access in the arm or leg.
The catheter in the neck or chest can be a temporary option in the hospital or even a long-term solution for some patients, however, in most situations, it is recommended to have this removed within 90 days due to increased risks of infection, vein narrowing, and reduction in future dialysis access options. For this reason, placement of an access point in the arm or leg is considered a first-line approach for patients on dialysis or close to needing dialysis.
This access point in the arm or leg involves connecting an artery and a vein together to create a circuit through which dialysis can be completed. This is called a fistula if the patient’s own arteries and veins are used. It is called a graft if the patient’s veins are inadequate to create a usable circuit and synthetic tubing must be used to create the artery and vein connection instead. This is where vascular surgeons like those at Vascular and Renal Care of Florida come in. Our goal is to create permanent dialysis access solutions in an expedited fashion so patients are ready for dialysis when the time comes or can have their catheters removed in a timely fashion.
Typically, the process involves a referral to a vascular surgeon to discuss the operation. This is followed by a referral for ultrasound mapping of the patient’s veins and arteries to assess their options for permanent hemodialysis access creation. Patients then see the vascular surgeon once more to book their operation and review the imaging. Operations are then performed in the hospital setting.
The process can be lengthy for chronic kidney disease and end stage renal disease patients to obtain their permanent access solution. Once the access is in place, it then takes 4-6 weeks to become usable (matured). By this time, many patients are well outside of the 90-day window during which their catheter should have been removed. It is estimated that at initiation of dialysis, a significant majority (79.5%) of patients are using catheters at their first dialysis session.
How do I obtain permanent hemodialysis access in the arm or leg?
Typically, the process involves a referral to a vascular surgeon to discuss the operation. This is followed by a referral for ultrasound mapping of the patient’s veins and arteries to assess their options for permanent hemodialysis access creation. Patients then see the vascular surgeon once more to book their operation and review the imaging. Operations are then performed in the hospital setting.
The process can be lengthy for chronic kidney disease and end stage renal disease patients to obtain their permanent access solution. Once the access is in place, it then takes 4-6 weeks to become usable (matured). By this time, many patients are well outside of the 90-day window during which their catheter should have been removed. It is estimated that at initiation of dialysis, a significant majority (79.5%) of patients are using catheters at their first dialysis session.
Why choose us at Vascular and Renal
Care of Florida?
We at VRCF are committed to timely evaluation, artery and vein assessment and placement of your dialysis access. Our center is an outpatient surgery center and clinic within the same building. Your appointment to meet your vascular surgeon, your ultrasound to have your arteries and veins assessed, and surgery can all take place in the same location. Our goal is to have your referral, imaging and surgery completed within 2-4 weeks of your first appointment.
Additionally, we are committed to monitoring your fistula or graft as needed following surgery. We ensure any potential issues are addressed prior to major complications with your access.
FAQs regarding dialysis access placement
What should I expect before surgery?
- You will be informed of any medications to stop or take prior to your operation
- Obtain lab work the day prior to your surgery either at your dialysis center or preferred lab collection facility
- Any significant lab abnormalities or concerns will be addressed and discussed with you prior to your operation
- Do NOT eat or drink at midnight the night prior to your operation. You may take your approved medications with sips of water.
- This does include juice, water, coffee, milk, broth, etc
What should I expect the day of surgery?
- You will be called and notified of an arrival time to the facility, usually set 1-2 hours prior to your operation time
- Please be patient, many factors in surgery centers, hospitals, etc can lead to surgery delays. Many of these are beyond your surgeon or the staff’s control.
- You must have a ride to and from the center. Your personal belongings can be left with this person during your operation
- Following your procedure, your surgeon will update you and your family and answer any questions you may have.
- You will be in the recovery area for at least 30 minutes prior to discharge. Your surgeon will check on you prior to you leaving the facility.
- You will be sent home with a prescription for pain medication if desired. If you are under the care of a pain management center, you may need to discuss pain medication adjustments with your provider.
What can I expect after surgery?
- No driving or operating heavy machinery for at least 1 week after the operation or within 24 hours of your last dose of pain medications
- Your dressing can be removed 2 days after your surgery, if you have incisions with visible suture, can paint with betadine or antibiotic ointment, cover with gauze and paper tape
- You may shower daily, please clean incision daily and let warm soapy water run over the incision, pat dry, do NOT rub
- If you have skin glue on your incision, this will peel off on its own and does not require wound care
- Your arm up to your shoulder may be swollen after surgery, mild to moderate is expected and can last for several weeks
- If experiencing bleeding and soaking through dressings every 1-2 hours, severe pain in your hand or cannot move and feel your hand even after your block has worn off (usually within 24 hours) please notify office immediately
- You will be given a follow-up visit with your vascular surgeon 2-3 weeks after surgery
- You will have an additional follow-up visit with an ultrasound of your fistula or graft and evaluation with your surgeon at 4-6 weeks after surgery, at this point your access may be cleared for use at your dialysis center
- ALL fistulas and grafts have risk of failure and will experience some degree of failure, it is important to have close observation of your dialysis access and to notify your vascular surgeon if any alarms or concerns are discovered at your dialysis center
- Prompt intervention can prevent complete fistula and graft failure
- Office hours are Monday to Friday 8 am to 5 pm, please call 352-561-8742 if any concerns arise during this time
- Otherwise, our answering service will be available after hours and on weekends to assist you
- Any significant concerns – fever greater than 101.5, white discharge from incision, chest pain, shortness of breath, redness and streaking from the incision should prompt immediate medical attention to your closest ER
What to do if fistula or graft fails?
- Obtain prompt medical attention if fistula or graft clots within 24-72 hours of the event as the fistula or graft will likely be able to be salvaged in this time frame
What fistula and graft maintenance services does your office provide?
- Our office is committed to ensuring the fistula or graft we create for you functions properly and as long as possible
- Overtime, fistulas and grafts can develop narrowing in the circuit, aneurysms (dilations of the fistula or graft), or difficulty maturing to the proper size for use
- Our office can offer minimally invasive and open surgical options to correct these issues