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Choosing Your Best Dialysis Access

Taking care of your access site is essential

With any type of dialysis access, proper care and attention to cleanliness are extremely important. In order to ensure effective dialysis treatment, be sure to follow your nurse’s exact instructions for access site maintenance including cleaning, checking for infection, and regular flow monitoring.

Types of Dialysis Access

Arteriovenous (AV) fistula

What It Is

An access site formed by the joining of a vein and an artery in your arm.

Healing time required before use

6 to 8 weeks

Which type(s) of dialysis it’s used for

In-center or home hemodialysis

Key considerations
  • It’s the preferred dialysis access for hemodialysis if you are eligible for this type of access.
  • It’s a more natural access site since it’s formed from your own blood vessels.
  • A fistula offers better blood flow and lowers the chances of infection and clotting as compared to a graft or a catheter.
  • If you are unable to have surgery for a fistula before you begin treatment, it may still be possible to get a fistula after starting hemodialysis.

Graft

What It Is

An access site formed by a piece of soft tubing that connects a vein and an artery in your arm.

Healing time required before use

2 to 3 weeks

Which type(s) of dialysis it’s used for

In-center or home hemodialysis

Key considerations
  • This access type is a better alternative if your veins are too small or weak for a fistula.
  • A graft offers better blood flow and lowers the chances of infection as compared to a hemodialysis catheter.
  • If you have a graft that fails, you and your doctor may be able to reconsider a fistula or a new graft in another location. Veins can sometimes get larger or stronger with time on dialysis.

Hemodialysis catheter

What It Is

A type of access created by a tube placed in your neck, chest or groin – often used temporarily while a graft or fistula is healing.

Healing time required before use

None – can be used immediately

Which type(s) of dialysis it’s used for

In-center or home hemodialysis though it’s usually not recommended for the long term.

Key considerations
  • A hemodialysis catheters a higher risk of infection and clotting due to the catheter tip’s location being near the heart.
  • It’s often used temporarily until fistula or graft surgery can be performed.
  • The access site must be kept dry.
  • There are limited bathing options and swimming is not recommended.

Peritoneal dialysis catheter

What It Is

A type of access created by a flexible tube placed in your abdomen – with a small piece of tubing left outside of the body that can be covered when not in use.

Healing time required before use

2 to 6 weeks, depending on the urgency to start treatment.

Which type(s) of dialysis it’s used for

Peritoneal dialysis only

Key considerations
  • The only access type for peritoneal dialysis.
  • No needles are used to perform dialysis.
  • Simple steps are needed to keep your access site clean.
  • A clean and sanitized treatment area at home is important to avoid infection.
  • A backup fistula (AVF) may be helpful in case hemodialysis is needed in the future.

Questions to ask your doctor or nurse to find out which type of access is right for you

Which types of access am I eligible for?

You may have some flexibility depending on your chosen dialysis treatment, your veins and your overall health. A vein mapping test can help determine your eligibility for a fistula or graft.

If I have a hemodialysis catheter, can I switch to another type of access site?

If you have a catheter for hemodialysis, it’s recommended that you switch to a fistula or a graft if you’re eligible. Hemodialysis catheters can have a lower blood-flow rate and higher risk of infection. Therefore, a hemodialysis catheter is not recommended for the long term unless your doctor has determined that it is the best type of access for you.

What’s the risk of clotting or infection for my access type?

It’s important for you to understand the risks and considerations associated with the access types.

Fistulas and grafts have a lower risk of clotting or infection than hemodialysis catheters – which is why those particular catheters are not recommended for the long term on hemodialysis.

What should I expect for placement surgery and recovery?

Access placement is considered minor surgery and is often done on an outpatient setting. Healing times vary, based on the type of access site.

Other people I’ve talked to haven’t changed their access sites. Why should I?

Even if you are healthy and doing well with your current access site, it’s still important to ensure that you have the best type of vascular access for you. Being proactive and getting your best access site can help minimize your risk of infection.

Do I need a vein mapping test?

To help you and your doctor determine the best type of vascular access for you, you should schedule a vein mapping test if you havent had one already. The test analyzes your veins to help your doctor assess your best choice for an access site. This test may also be repeated after you’ve been on dialysis, as veins can improve after being on treatment.

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