Dialysis Access

Overview of

Dialysis Access

Dialysis access is essential for patients with ESRD who require regular dialysis treatments to remove waste and excess fluid from the blood. Without adequate dialysis access, patients cannot undergo hemodialysis or peritoneal dialysis, which are life-saving treatments for ESRD.

Types of Dialysis Access

1. Arteriovenous (AV) Fistula: An AV fistula is created by surgically connecting an artery to a vein, usually in the arm. This creates a high-flow, low-pressure site for dialysis access. AV fistulas are considered the preferred type of access due to their long-term durability and lower risk of infection and thrombosis.
2. Arteriovenous (AV) Graft: An AV graft is a synthetic tube implanted under the skin to connect an artery to a vein. AV grafts are used when a patient’s blood vessels are not suitable for an AV fistula. They are more prone to infection and thrombosis than AV fistulas but are still considered a viable option for dialysis access.
3. Central Venous Catheter (CVC): A CVC is a temporary dialysis access used when immediate dialysis is necessary or when AV fistulas or grafts are not feasible. CVCs are associated with a higher risk of infection and thrombosis and are generally used as a bridge to more permanent access.

Indications for Dialysis Access

Dialysis access is indicated for patients with ESRD who require regular hemodialysis or peritoneal dialysis treatments. The type of access chosen depends on various factors, including the patient’s vascular anatomy, the anticipated duration of dialysis, and the patient’s overall health status.

Management of Dialysis Access Complications

1. Thrombosis: Thrombosed access sites may require thrombectomy or thrombolysis to restore blood flow.
2. Infection: Infected access sites may require antibiotics and, in severe cases, surgical debridement or removal of the access.
3. Stenosis: Stenotic areas may require angioplasty or stenting to widen the blood vessels and improve blood flow.
4. Hematoma: Small hematomas may resolve on their own, while larger hematomas may require drainage.
5. Steal Syndrome: Steal syndrome may require surgical revision of the AV fistula or ligation of the feeding artery.

Dialysis access is a critical component of renal replacement therapy for patients with ESRD. AV fistulas are the preferred type of access due to their long-term durability and lower risk of complications. However, AV grafts and CVCs are also used when AV fistulas are not feasible. Complications of dialysis access include thrombosis, infection, stenosis, hematoma, and steal syndrome, which require prompt recognition and management to optimize outcomes for patients requiring dialysis.