Before beginning hemodialysis treatment, a person needs access to their bloodstream, called “vascular access.” The access allows the patient’s blood to travel to and from the dialysis machine at a large volume and high speed so that toxins, waste and extra fluid can be removed from the body.
There are three types of vascular access:
- the Arterio Venous (AV) fistula
- the Arterio Venous (AV) graft
- the Central Venous Catheter or Internal Port Devices
Each access is created surgically. There are a limited number of places on the body where access can be placed—the arms, legs, neck or chest.
The fistula and graft are considered to be permanent accesses because they are placed under the skin with a plan to use them for many years. When patients find out they are in the advanced stages of chronic kidney disease and will be starting dialysis in the future, their nephrologist will advise them to get a fistula or graft. Having the access in place well before beginning dialysis will give this lifeline time to “mature,” so it can be ready to use.
When patients suddenly discover they have kidney failure, a catheter may be placed to allow for immediate dialysis treatment. The catheter will be used until a fistula or graft has time to mature. A catheter can also be used on a permanent basis if the patient is unable to have a fistula or graft—but a catheter is always the last resort.