PeaceHealth Medical Group - Surgery
Dialysis Access Surgery Procedure Guide
Kidneys remove waste from the blood. When the kidneys fail, they can no longer do this important work. Dialysis takes over the job of keeping blood clean. If you have severe chronic kidney disease but have not yet developed kidney failure, talk with your doctor about which type of dialysis may be best for you. The type of dialysis you receive will help determine the type of dialysis access you need.
There are two types of dialysis – Hemodialysis and Peritoneal Dialysis.
Hemodialysis is usually performed 3 times a week and takes about 3-5 hours. Two needles are inserted into your hemodialysis access, blood flows through one needle and connecting tube to an artificial kidney (dialyzer) where the blood is cleansed, then returned to your body through the second tube and needle.
Before hemodialysis is started, a way to access your bloodstream must be created. This access is meant to be permanent so that it can be reused for each dialysis session. The different types of access for hemodialysis are created during a surgical procedure and include the following:
Fistula – A type of vascular access that is created by connecting one of the arteries to one of the veins in the lower arm. Blood flows rapidly into the vein, enlarging it. A fistula allows repeated access for each dialysis session. A fistula may take about 6-12 weeks for the vein wall to thicken and the fistula to form and mature. A fistula may not clot as easily as other dialysis access methods. A fistula is the most effective type of dialysis access but is only used in about 25% of people who are receiving hemodialysis.
Shunt / Graft – A type of vascular access that uses a piece of synthetic tubing sewn between an artery and a vein if a fistula is not available. Blood flows rapidly through the graft from the artery to the vein. The tube is then used repeatedly for needle placement and blood access during hemodialysis. A graft doesn’t need to develop as a fistula does, so it can be used about 3-8 weeks after placement. This is the most common type of hemodialysis access.
Hemodialysis Catheter – Though typically not used for permanent access, a hemodialysis catheter may be used temporarily if kidney disease has progressed quickly and other access has not been obtained. In this case, a catheter is placed in a vein in the neck (jugular vein), chest (subclavian vein), or leg (femoral vein). Dialysis catheters are also used for patients needing dialysis while their permanent access develops.
Peritoneal dialysis is a technique used to remove waste products from the blood through the instillation of fluid into the abdominal cavity. Fluid is placed into the abdominal cavity and left for several hours after which it is removed. The fluid removed contains both wastes and extra fluid from the body. The special fluid used in this process is instilled and subsequently removed through a:
Peritoneal Dialysis Catheter – A special tube that is placed, during a short surgical procedure, into the abdomen which allows for the instillation and evacuation of fluid used in peritoneal dialysis. Placement of the catheter is usually done 10-14 days before dialysis starts.
Some types of peritoneal dialysis catheters may be used immediately (acute-use catheters). However, because of a high risk of complications with prolonged use, these catheters are not commonly used. A peritoneal dialysis catheter typically lasts about 3 years before needing replaced.
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