For Patients and Caregivers
Preparing For Your Appointment
- Arrive 15 minutes before your appointment time for pre-registration.
- Please bring your insurance card(s) and drivers license to the appointment.
- If you are going to be late or unable to make your appointment, please call our office and notify us as soon as possible at (614) 221-0222.
Anesthesia
Most hemodialysis access procedures involve use of some anesthesia. Please follow these guidelines accordingly:
- Do not eat or drink within 6 hours of your appointment.
- You can, however, take your regularly prescribed medications with a sip of water on the morning of your procedure.
- You will need to arrange for transportation to and from VACCO on the day of your procedure. You should not be driving, operating machinery, or making major or signing legal paperwork on the day of your procedure.
- If you are unable to arrange transportation for your procedure, please contact us or your dialysis clinic for assistance.
What to Wear and Bring With You
Please wear comfortable and loose-fitting clothing on the day of your procedure. We will provide you with a light snack following the procedure. If there are specific items you need. Please bring them with you to the appointment.
Educational Resources
Hemodialysis Access
In order to appropriately prepare for hemodialysis, hemodialysis access is required. To decrease the risk of bloodstream infections, an arteriovenous (AV) access is the best option.
A fistula is the preferred type of AV access, because it does not involve any synthetic material that would increase the chance of infection. An AV fistula needs to be placed 4-6 months prior to starting hemodialysis, to give it time to mature and be ready for use. A fistula is considered the “gold standard” of care in a hemodialysis patient. It is created by joining a native artery to a vein, which over time increases in size so it can be used for dialysis. Prior to the surgery, the veins may be “mapped” to determine the optimum placement of the AV access by the surgeon. The surgery is typically done as an outpatient. It takes a minimum of 2-3 months for maturation of a fistula (but some may take as long as 4-6 months). The fistula may require small additional procedures to help it get stronger.
An AV graft is another type of dialysis access. It is created by using a soft tube made out of synthetic material to help to connect the artery with the vein. A graft is chosen when the patient’s native blood vessels are too small or diseased to create a successful AV fistula. Using synthetic material increases the chance of infection compared to an AV fistula, but it is still a better option than starting dialysis with a hemodialysis catheter. The surgery is typically done as an outpatient. An AV graft can be used for dialysis in an average of 2-3 weeks; however, some newer synthetic materials allow the use of an AV graft immediately.
A hemodialysis catheter is a type of AV access that is normally only used on a short term basis, due to the high risk of infection. A blood based catheter is inserted into a large vein in your neck, chest or groin and the end of the catheter sits outside of your body. The procedure is performed by interventional radiologists or nephrologists in an inpatient or outpatient setting. The hemodialysis catheter can be used immediately, and can help with bridging a patient until their AV fistula or graft is mature enough for use. The is NOT allowed to shower with a catheter in place, and the exit site should be covered at all times with sterile dressing, to reduce the risk of infection.
Day-to-day Care of Your Vascular Access
There are certain guidelines you can follow help reduce the risk of infection, blood clots, and other problems with your vascular access:
- Be careful not to bump or cut your access.
- Do not sleep overnight on the side or arm of your access.
- Avoid very low blood pressures, as this can risk closure/clotting of the fistula/graft.
- Feel your fistula/graft daily; it should “purr” under your fingers (like a kitten; i.e. thrill). Your kidney doctor can show you how to check on your fistula/graft. If the thrill of the fistula/graft is reduced or disappears, notify your doctor or dialysis clinic immediately as it may require immediate attention and intervention.
- Avoid carrying more than 10 lbs (4.5 kg) with your access arm (i.e. a gallon of milk).
- DO NOT wear watches, jewelry, or tight clothes over your access arm which could restrict blood flow to that arm.
- Ensure your access is only used for dialysis.
- Before your dialysis treatments, clean the area around the access with antibacterial soap or rubbing alcohol and pat dry.
- Continue to follow limb precautions. DO NOT let anyone take your blood pressure, start an IV, or draw blood from your access arm.
Peritoneal Dialysis Access
Peritoneal dialysis (PD) is a treatment modality that is done at home. It involves placement of a special catheter in your abdomen either by using fluoroscopy and ultrasound guidance with moderate conscious sedation or with laparoscopic technique. The catheter needs to be placed 2-3 weeks prior to usage, although in special circumstances the catheter can be used almost immediately (with accommodations to the prescription because of the recent surgery). The catheter is used to place dialysis fluid into your abdomen; the fluid consists of dextrose or “sugar” water. The fluid is in your abdomen for several hours so it can remove toxins/waste and excess fluid from your blood indirectly, by using the outer lining of your gut as a membrane/filter, and then it is drained out again through the catheter. This process is called an “exchange”. Peritoneal dialysis can be done with the help of a cycler machine, which does the exchanges automatically while you are sleeping. For some individuals, the cycler is less effective so manual exchanges may need to be done.
Dialysis Access Q&A
What kind of access do I need for hemodialysis?
In order to do hemodialysis, access is needed to the bloodstream in order to allow removal of blood from one port through soft tubing, pass through a filter/dialyzer, and return the clean blood back into the bloodstream through another port. An arteriovenous access, such as an AV fistula or AV graft is preferred over a catheter due to its better dialyzing efficiency and lower risk of infection.
Who needs dialysis access?
If your physician has determined that your kidney function is advanced and you have a high risk of needing dialysis in the near future, then it is appropriate to undergo appropriate dialysis access planning.
What is the difference between a fistula and a graft?
A fistula is created by connecting your own body’s vein to a nearby artery. A graft is a synthetic vessel that is inserted under the skin to connect the artery to a vein and provide an area to insert needles easily for dialysis. A graft is appropriate for those who may not have adequate veins to form a successful fistula.
How do I know if my dialysis access is healthy?
Your dialysis care team will be regularly checking and evaluating whether your access is functioning well. If your access is not functioning well, they may refer you to the access center for further evaluation. Your dialysis care team will also provide you specific information on how to care for your access and when you should contact your physician if any problems arise.
Vascular Access Education and Outreach?
Our team members strive to educate patients, caregivers, and dialysis team members across Central Ohio on proper care and maintenance of hemodialysis access. If you have questions or are interested in vascular access education, please contact us directly for more information.
Please visit the following website: https://www.kidney.org/atoz/content/hemoaccess