Vascular Access of Hemodialysis

There are three basic kinds of vascular access for hemodialysis, an arteriovenous (AV) fistula, an
AV graft, and a venous catheter. The AV fistula is considered the best long-term vascular access
for hemodialysis because it provides adequate blood flow, lasts a long time, and has a lower
complication rate than other types of access. Besides that this form of vascular access is useful
because it causes the vein to grow larger and stronger for easy access to the blood system. [1] If an
AV fistula cannot be created, an AV graft or venous catheter may be considered as alternatives.
1.1 Arteriovenous (AV) Fistula
First looking at AV fistula, it requires advance planning. This is because a fistula takes a while
after surgery to develop. But this form of access is less likely to form clots or become infected
and they tend to last longer. An AV fistula is done by connecting an artery directly to a vein,
frequently in the forearm under local anesthesia. This then causes more blood to flow into the
vein. As a result, the vein grows larger and stronger and thus making repeated needle insertions
for hemodialysis treatments easier.
1.2 Arteriovenous (AV) Graft
If a patient has small veins that wont develop properly into a fistula, a vascular access that
connects an artery to a vein using a synthetic tube, or graft is used. The graft then becomes an
artificial vein that can be used repeatedly for needle placement and blood access during
hemodialysis. Since a graft doesnt need to develop, it can be used sooner after placement, often
within 2 or 3 weeks.

[1]

However, this form of access tends to have more problems with clotting

and infection.
1.2 Arteriovenous (AV) Catheter
If a patients kidney disease has progressed quickly, a venous catheter will be used as a
temporary access. A catheter is basically a tube that is inserted into a vein in neck, chest, or leg
near the groin. It has two chambers to allow a two-way flow of blood.

[1]

Once a catheter is

placed, needle insertion is not necessary. Catheters however are not ideal for permanent access
because they can clog, become infected, and cause narrowing of the veins in which they are
placed. A catheter can work for approximately several weeks or months while permanent access

develops. For those who fistula or graft surgery is unsuccessful, and they need to use a long-term
catheter access, the catheters are designed to be tunneled under the skin to increase comfort and
reduce complications. The disadvantages are such as increased hospitalizations, cannot shower
without special appliance and risk of destroying important vein.
1. Vascular Access for Hemodialysis. National Kidney and Urologic Diseases. Available from
http://www.kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/. Accessed on 1 July 2014