There are three types of vascular accesses for hemodialysis: an

arteriovenous fistula (AVF), an arteriovenous graft (AVG), and a central

venous catheter. An AVF provides a direct connection beteen the artery and
the vein alloing the vein to dilate and thic!en so that it may be accessed
repeatedly for hemodialysis. The AVF is generally accepted as the preferred
method for long"term dialysis access as it provides e#cellent blood flo for
dialysis, has the best longevity, and has a complication rate loer than the
other access types. $f an AVF cannot be created, an AVG or venous catheter
may be needed.Any type of dialysis access re%uires advanced planning as a
fistula can re%uire ee!s or months to develop to a point here it can be used
for hemodialysis. This should be preceded by a duple# ultrasound
e#amination (vein mapping) to determine hich veins are patent, the
diameter of these veins and the %uality of the veins in the arm. Additionally,
arterial inflo can be assessed to insure ade%uate flo to the access and to
the hand.An AVF is created on an outpatient basis. &atients are usually
administered a local anesthetic ith intravenous sedation. General
anesthesia can be avoided. &atients can e#pect some mild selling and
discomfort at the site. Fre%uent post"operative chec!s are important to
ascertain hen the fistula is 'mature()or ready to be accessed. $t is
common for the AVF to be used ith one needle initially adding the second
needle after *"+ successful cannulations ith one needle.An alternative to the
AVF is an Arteriovenous Graft (AVG). $f a patient has veins that are li!ely
not to sustain a fistula, a vascular access that uses a synthetic tube
implanted under the s!in can be placed. The tube serves ,ust as a vein ould
and can be used for access during hemodialysis. A graft does not re%uire the
same maturation time as a fistula , and, thus, can be used sooner after
placement""usually ithin to ee!s. Grafts tend to have more prone to
thrombosis and infection than AVFs but a ell placed AVG can serve a patient
ell for several years.The third option for dialysis access is a Central
Venous Catheter (CVC.) $f the patient-s !idney disease has progressed
%uic!ly, time may not allo for placement of an AVF or AVG prior to initiating
hemodialysis treatments. $nstead, they may need to use a venous catheter as
a temporary (bridge) access until an alternative is available. The goal is to
avoid use of catheters hen possible but .V.s do serve a very useful
function. A catheter is a tube that has to lumens (one to remove blood from
the body and the other to return it) inserted into a central vein (preferably the
internal ,ugular vein but, on rare occasions, the subclavian vein.) .atheters
are not ideal for permanent access as they can occlude, become infected, or
cause narroing of the veins in hich they are placed. /oever, if a patient
needs to begin hemodialysis immediately, a catheter ill suffice for several
ee!s or months hile their permanent access develops.For some patients,
hen a fistula or graft surgery is not successful, a long"term catheter access
must be used. .atheters that ill be needed for more than + ee!s are
designed to be tunneled under the s!in to increase comfort and reduce
complications.0ith every hemodialysis session, needle insertion is re%uired.
To needles are used 1 one to provide blood to the dialy2er and one to return
the cleaned blood to the body. 3ome patients prefer to insert their on
needles. &atients ill need training for this to learn ho to prevent infection
and protect their vascular access. 0hether a patient inserts their on
needles or not, they should !no about these techni%ues to further
understand and as! %uestions about their treatments.All three types of
vascular access 1 AVF, AVG, and .V.""can have complications that re%uire
surgical treatment. The most common complication is access infection
folloed by inade%uate blood flo to allo for effective hemodialysis. 0hen
accesses develop poor flo, intervention is necessary. Accesses ith poor
flo do not allo for effective hemodialysis. $n these circumstances, the
access may re%uire a fistulogram or duple# scan to identify the problem
causing the lo flo. 4epending on the findings during the diagnostic
procedure, an intervention (angioplasty or revision) may be re%uired to restore
proper function of the access. A patient can do several things to protect their
access:
5a!e sure their nurse or technician chec!s their access before each
treatment
6eep their access clean at all times
7se the access site only for dialysis
4o not allo blood dras or insertion of an $V line in their access arm
4o not ear ,eelry or tight clothes over their access site
4o not sleep ith their access arm under their head or body
.hec! the pulse in their access every day.