Dialysis access for End Stage Renal Disease (ESRD)

The key function of the kidneys is to clear toxins from the blood. When they fail, however, the patient might need dialysis to filter out the toxins. This can be temporary using catheters placed in the neck. If more permanent dialysis is required, an arteriovenous fistula or graft can be placed in the arm or thigh. Peritoneal dialysis is another option that can be undertaken by the patient at home.

Pearl

The type of dialysis access is tailored towards the needs of the individual patient.

What is dialysis access?

In order to perform dialysis and filter the blood from toxins, the patient needs to be connected to the dialysis machine. There are temporary and permanent options.

  • Temporary options consist of a variety of catheters that can be placed in the neck or in the groin. These can be short-term catheters (that can stay in place for up to 10-14 days) and long-term catheters (that can stay in place for a few weeks to months)
  • Permanent dialysis options are typically placed in the arm but can also be placed in the groin. They include arteriovenous fistulas (AVF) and arteriovenous grafts (AVG).
  • An AVF is created using the patient’s own veins. The surgery is usually performed on an outpatient basis. It involves connecting a vein to an artery. An AVF takes 6-8 weeks to mature (grow bigger and thicker) to the extent that dialysis nurses can stick needles into it and use it for dialysis.
  • If the patient has small veins, an AVG is usually the better option. It can also be placed on an outpatient basis. Most AVGs can be used within a couple of weeks of placement. Some can be used as early as the day following surgery.
  • Peritoneal dialysis is an alternative to hemodialysis. It involves the placement of a catheter into the belly. This catheter can be used at home, usually overnight, allowing the patient to continue with their life during the day.

Which dialysis access is best?

There are multiple factors. If urgent dialysis is needed, then a catheter will need to be placed. Catheters should be taken out as soon as possible to avoid long term complications like infection, clogging, and scarring of the big veins in the chest.

For long-term dialysis, AVFs are best as they last longer and are less prone to becoming infected or clogged up. An AVG is a suitable option if a patient has small veins that are unlikely to mature.

Peritoneal dialysis catheters can be used overnight, allowing patients to proceed with their daily activities without the need to go to a dialysis center three times a week.

Why NTSS?

Our providers have vast experience in placing and maintaining dialysis access. We believe in the fistula-first initiative, and in minimizing the use of hemodialysis catheters. Our services include:

  • New access placement
  • Revision of old accesses with problems like large pseudoaneurysms, ulceration, and bleeding
  • Ligation of an old access no longer needed
  • Salvaging thrombosed (clogged up) accesses to potentially prolong their life
  • Managing access complications like poor flow and steal syndrome
  • Advanced access placement to manage central vein blockages including advanced venography, venoplasty, stenting, and the placement of SuperHERO grafts