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If your kidneys are not effective clearing your blood of waste and excess water, it’s called kidney failure or end stage renal disease. Hemodiaysis is one of the options available to replace your kidney function, the other options are transplant and peritoneal dialysis.
Hemodialysis is a form of dialysis that uses a special machine to clean your blood. Your blood flows from your body to the machine, then goes through an advanced filtering system called a dialyzer or artificial kidney, and is then returned to your body cleared of waste, excess sodium, and fluids.
During hemodialysis, two needles with tubes attached to the hemodialysis machine are inserted into what is known as a vascular access in your arm. The hemodialysis machine takes blood from one of the needles, cleans it, then sends it back to your body through the other needle.
The entire procedure takes a few hours and is conducted three times a week. Your lab work determines the amount of time or cleaning your blood needs. Your nephrologist and dialysis team will be monitoring at your lab work regularly to make changes to your dialysis prescription that may be needed.
While hemodialysis is often done in a dialysis center, there many who chose to have the hemodialysis treatment done in their own home.
With home hemodialysis a partner is required to go through training with you, after you and your partner have completed the training you only need to visit the hemodialysis unit about twice a month. During these meetings you will meet with your team, and your lab work is reviewed for any changes that may be needed.
Home hemodialysis is usually done 5 or 6 days a week and for shorter periods of time compared to in-center hemodialysis, allowing for a gentler cleaning of your blood or dialysis treatment. Home hemodialysis treatments can be completed with your life and schedule in mind, allowing more independence and freedom.
Before you can begin hemodialysis, you will need a vascular access. This is an area on your body where two needles will be inserted before each hemodialysis session to allow your blood to flow in and out of your body.
There are three common types of vascular access that for dialysis. The planning process will begin by first identifying which type of access you will need, to do this a specialized ultrasound or vein mapping will be done to see if you are a candidate for an arteriovenous fistula (AVF) or a arteriovenous graft (AVG). The vein mapping process helps identify which access will be placed, along with the location of the access.
The 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 put in and taken out many times per week. 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 dialysis.
An AV fistula can be placed in an out-patient surgical area, or in a free standing interventional nephrology center.
An AV graft 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 doctor 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 blood clots.
If you find out your kidneys are failing and you need to start dialysis right away, your nephrologist may recommend that you get a central venous catheter (CVC). This catheter may be used if you have acute kidney failure or if there is not enough time to get an AV fistula or AV graft before you need to start hemodialysis.
What if I do not a permanent vascular access (fistula or graft) in place when it is time to start hemodialysis?
If you do not have a AV fistula or AV graft in place when it is time to start dialysis, your doctor might recommend that you have a central venous catheter placed. This type of catheter is a tube that goes under your skin and connects to a large vein deeper inside your body. It can be used until a permanent access is placed.
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, an AVF, or AVG, Peritoneal dialysis or a Kidney Transplant.
Your vascular access allows you to get the treatment you need; you might call it your “lifeline.” It is important to take care of it to protect your access, and to make sure your it is useful as long as possible.
Initially the care instructions come from the surgeon or interventional nephrologist who placed it. When the access is well healed your nephrologist and hemodialysis care team will give you individual instructions on how to care for it.
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