Hemodialysis Access - Lifeline of Patients - Things patients should know for better dialysis.

Kidney Support Network Podcast

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In this episode we talk about Vascular Access. The Access used in Hemodialysis and how patients can maintain health of their vascular access to keep it healther and working for longterm.

As you may know Hemodialysis is required when someone's kidney's stop working completely or are still working but can not sufficiently or completely remove waste materials from our blood stream.

The Hemodiaysis procedure is done by taking out blood from the body and waste material and extra fluid/water is removed from it by passing it thru a Filter which is called Dialyzer or an artificial Kidney also. The entire process is controlled by highly sophisticated machines.

The location or body parts from where patient's blood is taken out or re-injected in the body is called access site. And the access created at the site is named accordingly.

There are 3 types of access used in Hemodialysis:-

1. Arteriovenous Fistula (AV Fistula) - “AV” is short for arteriovenous, referring to the connection created between an artery and a vein. Your arteries carry oxygen-rich blood from your heart and lungs to the rest of your body. Your veins then carry oxygen-depleted blood back to the heart and lungs.

AV fistulas are usually created in the forearm but may sometimes be placed in the upper arm also by a surgeon or a Nephrologist. In this surgical procedure Artery coming into forearm is connected to the Vein. If possible it’s best to have the fistula placed in your non-dominant arm.

The Fistula surgery is a minor surgery and is generally performed in a day care setting which means patient is not required to get admitted in the hospital in most of the circumstances.

Once AV Fistula procedure is done generally it takes 30-45 days for the access to mature for effective usage for Dialysis.

To maintain an AV fistula, you should: keep the area clean, avoid wearing tight clothing or jewelry on the fistula arm, do not sleep on the fistula arm, avoid carrying heavy objects with that arm, regularly check for a "thrill" (vibration) over the fistula, and immediately report any signs of infection like redness, swelling, or pain;always consult your healthcare provider for specific instructions regarding your fistula care.

Key points to remember:

• Avoid compression: Don't wear tight clothes, bracelets, or watches on the arm with the fistula as they can restrict blood flow.
• Sleeping position: Never sleep on the arm with the fistula.
• Lifting heavy objects: Avoid carrying heavy bags or objects with your fistula arm.
• Check for "thrill": Regularly feel for a vibration (thrill) over the fistula to ensure proper blood flow.
• Monitor for infection: Watch for signs of infection like redness, swelling, pain, or warmth around the fistula area.
• Hand exercises: Perform gentle hand exercises to promote blood flow in the fistula.
• Blood pressure checks: Always use your non-fistula arm for blood pressure measurements.

2. Central Venous Catheters (CVC) - Third option is using a Central Venous Catheter. This access method is what more than 80% of dialysis patients use to start dialysis as CVC catheterisation can be done in a day care procedure and unlike AV Fistula, it can be used for dialysis immediately after placement. They Can be placed in Jugular Vein or Femoral Vein depending on the requriement and conditio

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