Learning About Hemodialysis and Vascular Access Surgery

What are hemodialysis and vascular access?

Before you can start dialysis, your doctor will need to create a vascular access. This is a place where the blood can flow in and out of your body during your dialysis sessions. Your doctor will prepare the vascular access weeks to months before dialysis starts. It's important to get your access as soon as your doctor says to. This allows your access to heal before you use it.

For dialysis to work best, the access needs to have a good, steady blood flow. It also must be sturdy since it will be used often, usually 3 times every week.

Hemodialysis is a way to remove wastes from the blood when your kidneys can no longer do the job. It's a lifesaving treatment when you have kidney failure. Hemodialysis is often called dialysis.

Learning about vascular access and dialysis can help you take an active role in your treatment. Dialysis doesn't cure kidney disease. But it can help you live longer and feel better. You will need to follow your diet and treatment schedule carefully.

How is vascular access surgery done?

The vascular access is where the needles are put that draw the blood from your body and send it through tubes to the dialysis machine. This access is also used to return the clean blood that is sent back into your body. There are two basic types of permanent vascular access:

AV fistula.

To make a fistula, your doctor will connect an artery to a vein in your arm. After the fistula heals, the dialysis needles can be put into it. Fistulas tend to be stronger and less likely to get infected than grafts. But they need to be prepared at least several months ahead of time.

AV graft.

To make a graft, your doctor will put a tube under the skin in your arm. The tube, or graft, connects an artery and a vein. The dialysis needles can then be put into the graft for dialysis. A graft is a good choice if you have small veins or other problems. A graft can sometimes be used as soon as 1 to 3 weeks after placement.

You will be asleep or get medicine to feel relaxed during the surgery. You will not feel pain. Your doctor will make a cut (incision) on the arm you use the least. If you are right-handed, the fistula or graft will probably be put in your left arm. If you are left-handed, it will probably be put in your right arm. Your doctor will close the incision with stitches. The incision will leave a scar that fades with time.

If you need to start hemodialysis right away, your doctor may place a tube in a vein in your neck, chest, or arm. This is called a central vascular access device (CVAD). It can be used while your permanent access heals. CVADs have more problems than an AV fistula or AV graft, so they aren't the best choice for permanent access.

If you get an AV fistula, you will probably go home the same day as the surgery. If you get an AV graft, you may spend 1 night at the hospital. You will probably need to take 1 or 2 days off from work.

What happens during hemodialysis?

Hemodialysis uses a man-made membrane called a dialyzer to clean your blood. You are connected to the dialyzer by tubes. They are attached to your blood vessels through your vascular access.

• Blood flows from your body into the dialysis machine through one of the tubes.
• In the machine, your blood is filtered. When your blood is in the filter, dialysate solution also goes through the filter. This solution takes waste out of your blood.
• The used solution is pumped out of the machine. Your clean blood returns to your body through the other tube.

How can you care for yourself at home?

• Be sure to have all of your dialysis sessions. Do not try to shorten or skip your sessions. You have a better chance of a longer and healthier life by getting your full treatment.
• Your doctor or health care team will show you the steps you need to go through each day before, during, and after dialysis. Be sure to follow these steps. If you do not understand a step, talk to your team.
• Your doctor and dietitian will help you design menus that follow your diet. Be sure to follow your diet guidelines.
  • You will need to limit fluids and certain foods that contain salt (sodium), potassium, and phosphorus.
  • You may need higher levels of protein in your diet.
• Your doctor may recommend certain vitamins. But do not take any other medicine, including over-the-counter medicines, vitamins, and herbal products, without talking to your doctor first.
• Do not smoke. Smoking raises your risk of many health problems, including more kidney damage. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Do not take ibuprofen (Advil, Motrin), naproxen (Aleve), or similar medicines, unless your doctor tells you to. These medicines may make kidney problems worse.