Dialysis Access

Your nephrologist will send you to an intervention nephrologist or surgeon ahead of time to come up with a plan that will fit you and your needs.  This assessment includes vein mapping to find the most suitable site as the first step, and then the type of access is defined and surgery will can be scheduled.  The surgery can happen right away or the surgery may planned for a future date depending on what your kidney function is.

The arteriovenous fistula (AVF) is the safest and most reliable type of vascular access. An AV fistula is a connection between an artery (a large blood vessel that carries blood from your heart) and a vein (a blood vessel that carries blood to your heart). In order to make an AV fistula in your body, you will need to have a minor surgery to connect your artery to your vein. This is most often done in your non-dominant arm. For example, if you are right-handed, you would probably get your fistula in your left arm.

Once the artery and vein are connected, more blood is able to flow through the fistula. After two to three months, the fistula will be stronger than a normal artery or vein, and will be able to withstand having needles placed for the hemodialysis process. Because the fistula needs time to heal and become strong, it is best to get an AV fistula two to three months before you need to start hemodialysis.

An AVF can be placed in an out-patient surgical area, or a free standing interventional nephrology center, if your veins are suitable you may be able to have a Percutaneous Vascular Fistula (PVF) placed requiring a very minimal access to your veins.

The arteriovenous graft (AVG) is the next best vascular access option. Instead of connecting your artery directly to your vein, an AV graft uses a plastic tube to connect the artery and vein inside your body. Like an AV fistula, the AV graft is made by a vascular surgeon during a minor surgery.  An AV graft is usually ready to be used in just two to three weeks. However, AV grafts are more likely to have problems with infections and clotting.

Central Venous Catheter (CVC) are utilized if your kidney function has decreased and there is no time for an AVF or AVG, and you need to start hemodialysis right away, your doctor may recommend that you get a central venous catheter (CVC).  A CVC is a tube that is inserted into a vein in your neck, chest or rarely your leg and hangs outside your body from an opening in your skin. Catheters often have problems with infection, clotting and scarring. Therefore, this type of vascular access should only be used for short periods of time unless otherwise necessary.

If you would like to learn more about hemodialysis or any of the treatment options you can visit with a nurse educator from SA Kidney.

For those on hemodialysis and have a fistula or a graft, it is sometimes necessary to preform interventional procedures to improve or restore the blood flow.  This procedure can all be accomplished at the SA Kidney Access Center.  This eliminates the need for hospital stays and patients are able to return to their daily lives or hemodialysis with little interruption.

For those on peritoneal dialysis, occasionally the catheter will need to be adjusted and we can do that at the SA Kidney Access Center with guided imagery.  It is important to have a well-placed catheter to assure you are getting the best dialysis clearances possible (clean blood).

We like to consider these vascular catheters temporary, if needed at all.  The goal is to prevent them all together by having a plan in place ahead of time that would include; an AVF, an AVG, Peritoneal dialysis, or a Kidney Transplant.

If you would like to learn more about hemodialysis or any of the treatment options you can visit with a nurse educator from San Antonio Kidney.

There are two choices when a hemodialysis access is needed but when there is insufficient time for a permanent access to be placed, or if the access gas beeb placed and is not healed or ready for use, you may need to have a central venous catheter placed (CVC) placed.

A CVC is usually placed by the interventional nephrologists in our San Antonio Kidney Access Center, and these catheters can be placed so you can begin hemodialysis as soon as possible.  These catheters are sometimes placed in the hospital.  The CVC does allow for the essential initiation of hemodialysis, but a plan for permanent access is still necessary.

The second option is urgent start peritoneal dialysis.  A peritoneal dialysis (PD) catheter is placed in the usual manor, but instead of waiting 2-3 weeks to begin training, low volume treatments begin soon after PD catheter is placed.  The PD team will see you more often to preform and assist with these low volume treatments until you are ready for full volume, this prevents the need for a CVC.

Patients will receive exceptional care individualized to meet their needs.  Along with your nephrologist the team at our access center will keep you informed and assure you are comfortable as you move through the process.

Peritoneal dialysis (PD) requires that a peritoneal catheter to be placed in your abdominal cavity, this allows specialized fluid to flow in and out of the abdominal cavity and when fluid is removed so are the toxins and extra fluid.

If PD is your choice, your nephrologist will have you meet with a peritoneal training nurse in your home to assess if your home is satisfactory for PD and to answer any questions you or your family may have about PD.  The nurse will be assessing your bedroom and bathroom to see what your individual situation, to assess what will be required when the nurse is training you to preform PD.  The nurse will also make any recommendation for storage of supplies that will come into your home for PD.  This home visit is required by CMS and other providers.  The goal of this home visit to assure this is the right choice for you and all of your questions regarding training for PD are answered.

The next step for PD preparation is a visit to the San Antonio Kidney Access Center or to a General Surgeon so your abdomen can be assessed, specifically your peritoneal membrane.  This testing is usually done via an ultrasound, which will be looking at your abdominal cavity in search of any abnormalities that would prevent you from doing PD successfully.

When the home visit and PD abdominal assessment has been completed, your plan is in place.  When the time comes and your nephrologist feels the you need to start PD, you will be scheduled for a PD catheter placement, when the catheter insertion site is healed you will start working with the PD nurse and be trained for approximately two weeks to learn how to do the PD treatments.

When training the is completed, you will need to visit the PD clinic twice a month so your team and review your monthly lab work and check your health status.

Your PD team will keep you informed and guide you through this process.

If you would like to learn more about PD or any of the treatment options you can visit with a nurse educator from San Antonio Kidney.