Dialysis and Venous Access
When a patient’s care plan involves receiving dialysis, our surgical team can help their experience by providing improved vascular access options.
What is vascular access for dialysis?
During dialysis a patient’s blood is filtered through a dialysis machine over many hours during several sessions. The reason the process takes a long time is because the needles only allow a small amount of blood to pass through. A vascular access allows for a larger amount of blood to flow continuously during dialysis treatments. This can significantly cut down the time required for dialysis treatments allowing the patient to return to their lives away from the dialysis clinic.
There are two ways to achieve vascular access: arteriovenous (AV) fistula and the AV graft. Both forms need to be installed several weeks before starting dialysis treatments. This allows the veins and arteries time to heal and prepare for the larger blood volume.
What is an AV fistula?
An AV fistula is a connection made by a surgeon in the forearm or upper arm which develops and grows the vein to make it larger and strong enough for the increased blood volume. The AV fistula is often recommended because it provides quality blood flow, lasts longer than other forms, and is less likely to have complications like infection or clotting.
What is an AV graft?
If an AV graft is more appropriate, a surgeon will implant a plastic tube to connect an artery to a vein. The dialysis connection is then made to the tube so that the arterial blood passes through the tube, to and from the dialyzer machine, before returning to the body via the part of the tube directed to the vein.
How is an AV fistula or AV graft installed for dialysis?
The installation of either access is performed as an outpatient procedure in our offices or in a hospital. The patient’s arm will receive a local pain blocker and our surgeon will perform the delicate surgery to prepare the artery for future dialysis treatments.
How do you care for an AV fistula or AV graft?
Our care team will help the patient understand how he or she should care for the fistula or graft. Properly cleaning and monitoring the AV fistula or AV graft will help to detect and prevent infections and/or blood flow issues.
One way to check for blood flow is by feeling for the vibrations caused by the heartbeat, known as the “thrill”. Patients are instructed to avoiding bumping, damaging, or impairing the access the AV device. Tight fitting clothing, jewelry, pressure on the area from carrying heavy objects, even blood pressure cuffs should be avoided as they can restrict blood flow to the vascular access.
Tunneled Catheter and Port Placement
Sometimes a patient’s treatment plan requires long-term access to a vein to deliver medications or fluids or have blood drawn. To help a patient feel more comfortable and reduce the number of needle sticks, physicians may request a tunneled catheter or implanted port be placed.
What is a tunneled catheter?
A tunneled catheter is a thin tube placed under the skin in a vein. One end of the catheter remains outside of the body while the other end is carefully guided into a larger central vein.
What is an implanted or infusion port placement?
Similar to a tunneled catheter, a medical port (formerly known as a totally implantable venous access device) helps to deliver medications, fluids, nutrition and obtain blood samples. A port is a small medical device that is installed under the skin. One end of the port has a self-sealing silicone surface that can be repeatedly punctured by needles so that the patient does not need to be. Under this silicone is a reservoir attached to a tiny catheter. The catheter is guided through a vein to a larger central vein or artery.
Both a tunneled catheter and implanted port require experience and state-of-the-art equipment to be properly placed. Our surgical staff can detail the procedure, explain the risks and benefits of either, and schedule the procedure.
Peritoneal Dialysis Catheters
What is peritoneal dialysis?
When the kidneys can no longer properly filter the toxins and waste from the blood supply, medical intervention is necessary. A dialyzer machine can be used to filter the blood. This is referred to as receiving dialysis. In hemodialysis, blood is taken and returned via the arm. This is typically done in a medical care facility, like a dialysis center or hospital. This procedure can take hours and requires a patient be away from home or work for long durations. Unlike hemodialysis, a peritoneal dialysis does not require a care facility, which is ideal for people who may not be a good candidate for hemodialysis.
What is a peritoneal dialysis catheter?
Our board-certified surgeons can place a peritoneal dialysis catheter for patients who are candidates for this type of procedure. A peritoneal dialysis involves placing a catheter tube into the abdomen to allow the lining of the peritoneum to act as a filter for the blood. What is filtered needs to flow out of the abdomen and be discarded. During peritoneal dialysis, the catheter will be used to deliver a dialysate, a medication that adds the peritoneum in filtering waste, chemicals and excess fluid from the blood. When the cycle is complete, the catheter is then used to draw the dialysate and waste products from the body into a sterile collection bag.
Our surgical team can perform an assessment, explain the risks and benefits of a peritoneal dialysis catheter, schedule tests and the procedure, place the catheter, and provide post-surgical care instructions and follow-up for patients.