What is permanent hemodialysis access?

Hemodialysis is a way to remove wastes from the blood when your kidneys can no longer do the job. It is not a cure, but it can help you live longer and feel better. It is a lifesaving treatment when you have kidney failure. Hemodialysis is often called dialysis.

Before you can start dialysis, a doctor will create a place where the blood can flow in and out of your body during dialysis. This is called the hemodialysis (or vascular) access.

There are two basic types of permanent vascular access.

• AV fistula: To make a fistula, a doctor will connect an artery to a vein, usually in your arm. Fistulas tend to be stronger and less likely to get infected than grafts. But they need to be prepared several months ahead of time. After that, the dialysis needles can be put into the fistula.
• AV graft: This is a good choice if you have small veins or other problems. A doctor will put a tube under the skin in your arm. This tube is the graft. It connects an artery and a vein. The dialysis needles can then be put into the graft. A graft can sometimes be used as soon as 2 weeks after placement.

You will get medicine to numb the area and help you feel relaxed during the surgery. The doctor will make a cut on the forearm of the arm you use the least. This cut is called an incision. The doctor will close it with stitches. The incision will leave a scar that fades with time.

You will probably go home the same day as the surgery. You will probably need to take 1 or 2 days off from work after the surgery.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

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.

Hemodialysis is a way to remove wastes from the blood when your kidneys can no longer do the job. It's not a cure, but it can help you live longer and feel better. It's a lifesaving treatment when you have kidney failure. Hemodialysis is often called dialysis. Your doctor created a place (called an access) in your arm for your blood to flow in and out of your body during your dialysis sessions.

Your arm will probably be bruised and swollen. It may hurt. The cut (incision) may bleed. The pain and bleeding will get better over several days. You will probably need only over-the-counter pain medicine. You can reduce swelling by propping up your arm on 1 or 2 pillows and keeping your elbow straight.

You will have stitches. These may dissolve on their own, or your doctor will tell you when to come in to have them removed. You should also be able to return to work in a few days.

You may feel some coolness or numbness in your hand. These feelings usually go away in a few weeks. Your doctor may suggest squeezing a soft object. This will strengthen your access and may make hemodialysis faster and easier.

You should always be able to feel blood rushing through the fistula or graft. It feels like a slight vibration when you put your fingers on the skin over the fistula or graft. This feeling is called a thrill or a pulse.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.