Vascular Access for Hemodialysis

If you will be starting hemodialysis treatments in the next several months, you will need to work with your health care team to learn how the treatments work and what you can do to get the most from them. One important step before starting regular hemodialysis sessions is preparing a vascular access, which is the site on your body where blood will be removed and returned during dialysis. To maximize the amount of blood cleansed during hemodialysis, the vascular access should provide high volumes of blood flow continuously during treatments.

A vascular access should be prepared weeks or months before you start dialysis. It will allow easier and more efficient removal and replacement of your blood with fewer complications. There are three basic kinds of vascular accesses for hemodialysis: an arteriovenous (AV) fistula, an AV graft, and a venous catheter. A fistula is an opening or connection between any two parts of the body that are usually separate, for example, a hole in the tissue that normally separates the bladder from the bowel. While most kinds of fistula are a problem, an AV fistula is useful because it causes the vein to grow large and strong for easy access to the blood system. The AV fistula is considered the best long-term vascular access for hemodialysis because it provides adequate blood flow for dialysis, lasts a long time, and has a complication rate lower than the other access types. If an AV fistula cannot be created, an AV graft or venous catheter may be needed.

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