If you choose hemodialysis as your dialysis modality, you should be evaluated for a vascular access. It is important to plan early for your access because it is needed for your hemodialysis treatments.
There are three types of vascular access used for hemodialysis. Two types are intended for long-term use and are recommended by health care providers because these have the lowest risks. These types of access include a fistula and a graft. The third type is a hemodialysis catheter and is intended for short- term use.
The long-term access are preferred and take a bit more planning. A fistula (AVF) is an outpatient surgical procedure where your artery is connected to your vein in order to make the vein larger and stronger. After 6-8 weeks, this vein will be used for dialysis when it is large enough or “mature”. A graft (AVG) is an outpatient surgical procedure where an artificial tube is used to connect your artery to your vein. This tube is tunneled under your skin by a surgeon and will be used for dialysis. Depending on the type of graft, it may be ready to use for dialysis within a few days to two weeks after the procedure.
A tunneled hemodialysis catheter is a catheter or tube which is placed into a large vein in the neck or groin. It is located or placed close to your heart and the surgeon “tunnels” it under your skin. This type of dialysis access is usually short-term and is placed in situations where you may need urgent dialysis.
If you decide to have hemodialysis, you should be referred to a vascular surgeon for evaluation & vein mapping. This will help determine if you are a candidate for an AV fistula or AV graft. Your healthcare provider can help you schedule this appointment before you need hemodialysis even if you are feeling well. Giving your vascular access time to mature helps prevent some problems. Ask your healthcare provider for more information on vascular access.