Establishing the right kind of dialysis access is extremely crucial to a patients' effective dialysis treatment.
There are four types:
Three types are used for hemodialysis and one type is the access introduced through the abdominal lining of the patient.
Central Venous Catheter (CVC)
Arteriovenous Fistula (AV fistula)
Arteriovenous Graft (AV graft)
Peritoneal Dialysis Catheter
An AV fistula is access made by surgically connecting an artery and vein. It is usually prepared in the non-dominant arm.
However, sometimes AV fistula is also prepared in the leg. Once the fistula is made, it will be several months before it is used for dialysis. It needs to completely heal and mature for it to be used.
An AV fistula allows a greater rate of back and forth blood flow from through the vein to the dialysis machine. This strengthens the vein as well.
AV fistula is considered to be a Gold Standard for all types of hemodialysis access treatments.
One needs to care for the fistula by checking for any redness, swelling or pain, or bleeding at the site of fistula formation.
The patient is also expected to regularly check for the pulsation of blood flow through the fistula. Any anomalies should be reported to the doctor immediately.
The obvious benefits are that it can be used for several years and has less susceptibility to be infected.
However, there is a downside. Only once the fistula is successful can the access be useful, if the fistula fails the will have to be another access used.
Additionally, for each dialysis sitting, a needle needs to be inserted for the procedure to access the fistula.
An AV graft is used for patients where the veins and arteries are small to have a fistula formation.
Instead of having the artery and vein fuse, a small tube (artificial), referred to as a graft is used to connect the vein to the artery.
One has to care for the graft just like for the fistula.
It is performed under an outpatient procedure. Compared to the fistula it takes only three to four weeks to stabilize.
However, its disadvantages are that it has a shorter life and may need replacement. It is prone to clotting.
This type of dialysis involves using the lining of the patient's belly and a dialysate solution. It is a procedure, which is preferred for patients that are continuously on the move.
This method can be performed at home safely, within a shorter time. However, it is not recommended for patients with inflammatory bowel disease, abdominal hernia, and large surgical scars on the abdomen, or recurrent diverticulitis.
Patients identified suitable for this access of dialysis, should know that this procedure is associated with a high risk of infection to the abdominal lining.
This is especially the tunnel the catheter makes when threaded through the abdominal lining. The patient must carry out strict sterilization procedures to avoid the risk of infections.
The certain advantages are that it is an outpatient procedure and there is no usage of needles needed. As mentioned earlier, it can be performed at home.
The patient only needs to be cautious about the sterilization protocols and report any discomfort, as this method is prone to clotting.
A CVC is considered when the patient needs emergency dialysis and does not have an AV fistula or graft.
It is not used for a long-term or permanent type of access. It uses a Y-shaped tube, flexible and long which is introduced through the skin into a central vein either in the neck, chest, or groin area.
It is generally performed as an outpatient procedure.
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