Dialysis Access Management

Dialysis access management is a crucial aspect of caring for individuals with late-stage renal disease that require dialysis treatment. Dialysis access refers to the points through which blood is retrieved for hemodialysis or peritoneal dialysis treatments. The goal is to maximize the function, longevity, and safety of the access points while ensuring efficient and reliable therapy. Regular monitoring, intervention, and patient education are essential for a comprehensive management program. By maintaining healthy access and addressing potential complications promptly, healthcare providers can maximize the effectiveness of dialysis treatments and improve the quality of life for individuals relying on dialysis therapy.

Dialysis Access Management Q & A

What are the types of dialysis access?

There are two types of dialysis access: hemodialysis and peritoneal dialysis. Hemodialysis is used to remove waste products and excess fluids from the blood when the kidneys are unable to perform this function adequately. During this procedure, blood is circulated outside the body through a machine known as a dialyzer or artificial kidney. Peritoneal dialysis is another form of renal replacement therapy. Unlike hemodialysis, this treatment utilizes the peritoneum – a membrane lining the abdominal cavity – as a natural filter.

What is an AV Fistula?

An arteriovenous (AV) fistula is a surgical connection of a vein and an artery in your arm or leg. It is a type of vascular access commonly used in patients who require long-term dialysis treatments. The AV fistula provides a more reliable access point for recurring treatments. One needle is used to draw blood from the patient’s body into the dialyzer, where waste products and excess fluids are removed, and the cleansed blood is then returned to the patient’s body through the second needle. Regular monitoring and care are necessary to ensure the fistula remains functioning properly and to address any issues that may arise.

What is an AV Graft?

An AV graft, also known as an arteriovenous graft, is an alternative type of vascular access used for dialysis when creating an AV fistula is not possible or is unsuccessful. Like an AV fistula, an AV graft provides a means to connect an artery and a vein to facilitate the circulation of blood during dialysis treatments. A synthetic tube, usually made of a biocompatible material such as polytetrafluoroethylene (PTFE), is required to create the connection. One end of the graft is attached to an artery, typically in the forearm or upper arm, while the other end is connected to a nearby vein. The AV graft functions similarly to an AV fistula by allowing arterial blood to flow into the vein.

How long will my dialysis access last?

The lifespan of dialysis access varies depending on the type, patient health, location, and other factors. AV Fistula is the most stable and has the longest lifespan. With proper care and maintenance, an AV fistula can maintain function for 10 to 20+ years. AV grafts have a shorter lifespan. On average, this type of graft can last between 3 to 7 years.

How do I preserve my dialysis access?

Regular maintenance of your dialysis access is crucial to ensure its longevity and optimal function. Clean the access points with mild soap and water regularly, especially before dialysis sessions. Avoid using lotions, creams, or powders on or around the access site, as they can increase the risk of infection. Avoid carrying heavy objects or wearing tight clothing or jewelry that can compress or irritate the access. Exercise caution while performing activities that may pose a risk of trauma to the access site. Keep your blood pressure maintained, stay hydrated, and attend your regularly scheduled check-ups to monitor any changes that occur.

If you self-cannulate, ensure proper techniques are followed. Proper needle insertion helps minimize the risk of complications such as infection, bleeding, or aneurysm formation. Always alternate between access points for every treatment. Follow the instructions provided by your healthcare provider regarding needle insertion and care.

What are the side effects and complications associated with dialysis access surgery?

Side effects associated with dialysis access surgery include mild to moderate pain or discomfort, swelling, bruising, limited motion, and scar formation. Complications may include infection, incision breakdown, steal syndrome, arterial stenosis, poor maturation, blood clots, and/or aneurysm formation. While these complications may occur – proper care, regular monitoring, and adherence to medical recommendations can minimize or mitigate certain conditions. Your healthcare team will closely monitor your dialysis access, provide guidance on care and maintenance, and address any complications that may arise.

What is steal syndrome?

Steal syndrome, also known as dialysis access steal syndrome or access-induced ischemia, is a condition that can occur in patients with arteriovenous (AV) access for hemodialysis. It is a complication that arises when the access site diverts blood away from the surrounding tissues, leading to inadequate blood supply and lack of oxygen in the affected area – usually the hands and/or fingers.
Symptoms of steal syndrome include coolness of the hands/fingers, numbness or tingling sensations, loss of coloration, weakness or fatigue of the hand, pain, and poor wound healing. If left untreated, steal syndrome can cause tissue damage or necrosis. Your healthcare provider may modify your dialysis treatments to reduce resistance in the affected area. For severe cases, surgical intervention may be required to repair the access point.