Understanding How a Dialysis Access Placement Works

You have two kidneys, and their primary job is to remove waste products and water from the blood, excreting them as urine. If your kidneys fail to function normally, you may have to undergo hemodialysis, an external machine that removes the waste for you. For that, you need an access port.

At Heart Vascular & Leg Center, our expert team of vascular specialists routinely provides dialysis access for our patients in the Bakersfield, California, area with impaired kidney function. A few different techniques can be used, so our team put together this guide on how a dialysis access placement works.

How are kidneys supposed to work?

Most people have two kidneys, each about 10-15 cm long and weighing about 160 g, located deep in the abdomen with one on either side of the spine. It’s possible to survive with only one kidney, and, on occasion, a person may be born with three.

The kidneys’ main job is to remove toxins from the blood and transform the waste into urine. Together, the two kidneys filter 200 liters of fluid every 24 hours.

When the kidneys don’t work properly, toxins and excess fluid build up in the body, which may cause symptoms that include high blood pressure, extreme fatigue, persistent headaches, swelling in the face and ankles (edema), and/or lower back pain.

In addition to filtering the blood, the kidneys keep electrolytes (especially sodium and potassium) in balance and maintain a constant volume of water in the body. They also secrete several of essential hormones that regulate salt and water balance, blood pressure, and the production of red blood cells.

What is hemodialysis?

If your kidneys can’t function properly, your blood has to be cleaned through an external machine to prevent toxin buildup, and the cleaned blood is returned to your body. The process is known as dialysis. Because you need to have this done every few days, it’s important to have an easy access point to hook you up to the machine. There are a few different types of placement procedures.

1. Arteriovenous (AV) fistula

An AV fistula access consists of a connection between an artery and a vein in your non-dominant arm or wrist. It provides the needed blood flow, can last for years, and is less likely than other access types to become infected or form clots. As a result, it’s considered the gold standard of hemodialysis access. An AV fistula takes several weeks to develop after it’s placed, so the procedure takes place several weeks before your anticipated treatment start date.

2. Arteriovenous (AV) graft

If developing a fistula isn’t possible, you may need an AV graft. A good example is if you have small veins. The surgeon places a synthetic tube under your skin to connect an artery with a vein, serving as an artificial vein. An AV graft can usually be used within 2-3 weeks after placement. They’re more prone to infections than AV fistulas, but if you keep the graft dry and clean, it can last for years.

3. Venous catheter

A venous catheter contains two chambers — allowing for two-way blood flow — and is placed in a vein in your neck, chest, or leg. Our surgeon may need to place a cuff under the skin to hold it in place. Catheters don’t allow blood to flow as quickly as other access types, and they have a higher chance of becoming infected. However, if you need to start dialysis right away, the doctor will go this route. It’s considered only a temporary solution.

Your Heart Vascular & Leg Center surgeon provides whichever form of dialysis access your referring physician requests, but they prefer to place AV fistulas for the benefits indicated above.

If you’re showing signs of kidney disease, or your doctor has informed you that you need hemodialysis, it’s time to come into Heart Vascular & Leg Center for an evaluation and dialysis access placement. Give our office a call at 661-443-5524 to schedule, or book online today.