Dialysis Access Surgery

Overview

You may know that the kidneys are one of the most important organs of your body. When they stop working properly, it can create several health issues. One of the most significant functions performed by kidneys is the removal of waste products and excess fluid from the blood. When the kidneys are not able to perform this function, you may need dialysis.

Dialysis is a treatment for people with non-functioning kidneys. It does the work of the kidneys and removes waste products and excess fluid from the blood. Dialysis is a requirement for people with kidney failure or end-stage renal disease (ESRD). 

There are two types of dialysis:

• Hemodialysis: In this type of dialysis, a machine removes blood from the body, filters it, and returns the purified blood to the body.
• Peritoneal dialysis: This type of dialysis includes the placement of a small tube (cannula) in the abdomen and filtration of blood through the lining of the abdomen (peritoneum).

In this article, we will be talking about hemodialysis, which will simply be referred to as “dialysis”. 

Before starting hemodialysis, you need to undergo a surgical procedure to have access placed in your body, which makes it easier to receive dialysis. Let’s find out more about dialysis access in this article.

What is Meant by Dialysis Access?

Dialysis access, also called “vascular access”, “vascular access for hemodialysis”, or simply “hemodialysis access”, is a surgically created vein used to remove and return blood during hemodialysis. The access allows blood to travel through tubes to the dialysis machine, where it is cleaned by a filter called a dialyzer. 

The placement of the access is by a minor surgery. It can be done in an outpatient setting and does not require hospitalization.

What Are The Types of Dialysis Access?

There are three different types of dialysis access:

1. Arteriovenous Fistula (AV Fistula): An “arteriovenous fistula for dialysis” or “AV fistula for dialysis” is made by surgically connecting an artery and a vein in your arm, or in some cases, your leg. This surgical connection between an artery and a vein in patients who require dialysis is commonly called a “dialysis shunt”.

It allows a higher rate of blood to flow back and forth from the vein to a dialysis machine. An AV fistula is the most preferred dialysis access type and can generally be constructed using only one incision. 

After an AV fistula surgery for dialysis is successful and healed, two needles are placed into the access at the beginning of each dialysis and connected to soft tubes that go to the dialysis machine. Your blood reaches the machine through one of the tubes. The blood passes through the dialyzer and is cleaned. At last, the blood returns to your body through the other tube.

2. Arteriovenous Graft (AV Graft): An AV graft for dialysis is made by using a piece of soft, hollow, synthetic tube to join an artery and vein in your arm. Like an AV fistula, an AV dialysis graft also contains a surgical connection between an artery and a vein, and can be called a “dialysis shunt”.

This type of dialysis access is used if you have blocked or damaged veins or veins that are too small for an AV fistula. It can generally be constructed with only two small incisions. 

Just like an AV fistula for dialysis, with an AV graft also, two needles are placed into the access at the beginning of each dialysis and connected to soft tubes that go to the dialysis machine. Blood travels to the machine through one of the tubes, passes through the dialyzer, and is cleaned. The blood returns to your body through the other tube.

3. Central Venous Catheter (CVC): A central venous catheter (CVC) is a long, flexible Y-shaped tube made out of plastic. There are two parts to the tubing, one for removing blood and the other for returning the cleaned blood to the body. 

The arm is not chosen for this dialysis catheter placement. Rather, it is threaded through the skin into a central vein in the neck, chest, or groin. 

It is not intended to be a permanent type of access and is required when you need emergency dialysis and cannot receive an AV fistula or AV graft. The catheter can be connected to the dialysis tubes without the use of needles.

What is The Preparation Required Before Dialysis Access Surgery?

• Before planning a dialysis access surgery , consult an expert surgeon with hemodialysis experience to understand the pros and cons of each type of access. 
• The surgeon can evaluate your health condition and help you choose the type of access suited to your case. 
• In preparation for access placement, you and the surgeon can work together to choose an access site through a process called vessel mapping. It includes: 
  • Discussing the history of any past peripheral artery disease
  • Performing a test to determine blood flow rate using ultrasound, venogram, or X-ray 
  • Analyzing the depth and size of the veins and arteries
• The surgeon will also take stock of your complete medical and surgical history before scheduling the surgery. 
• Inform the surgeon about any medications, supplements, and herbs you take. You may be asked to discontinue certain medications, for example, those that could increase the risk of bleeding during surgery. 
• You may be asked not to eat or drink anything other than water for at least 8 hours before the procedure. 

How Does Dialysis Access Surgery Work?

• Dialysis access surgery is generally an outpatient procedure, and patients can go home on the day of the surgery.
• The surgeon may give you a sedative to help you relax before the procedure.
• Dialysis access surgery is generally performed under local anesthesia. The anesthetic is administered at the chosen site, which is generally the forearm of the non-dominant arm. 
• For an AV fistula surgery for dialysis, a small incision is created on the forearm to allow the surgeon access to the selected arteries and veins. The surgeon divides the vein and sews it to the side of an artery where an opening has been made. It typically takes between 2 to 3 months for an AV fistula access to be ready for use in dialysis.
• For an arteriovenous (AV) graft access creation, a small incision is created on the upper or lower arm to allow the surgeon access to the selected artery and vein. A soft tube (graft) is sewn to a vein and the other end of the tube is connected to an artery. It typically takes between 2 to 3 weeks for an AV graft to be ready for use in dialysis.
• If dialysis needs to be carried out urgently, the surgeon may place a central venous catheter (CVC) into a vein in your neck, chest, or leg for temporary access.

What to Expect After The Dialysis Access Surgery ?

• Once the procedure is complete, you may experience mild to moderate pain, discomfort, and swelling for the first few days. 
• The surgeon may ask you to keep the access raised above your heart level to reduce swelling and pain at the access site. They may also prescribe a painkiller to manage pain. 
• Expect to feel numbness in the hand, but it should resolve in a few weeks as circulation regularizes.
• You may be advised to relax and recover at home for a few days. It may take a few weeks before you start feeling better. 
• Discuss with your surgeon before going back to work or resuming strenuous physical activities.
• During recovery, remember these dos and don’ts:
  • Do keep the incision dry for at least 2 days post-surgery.
  • Don’t lift heavy items (more than 5 kg) with the access arm for 3 weeks after the surgery. 
  • Don’t use the access arm to push or pull items such as doors for 3 weeks. 
  • Do use the non-access arm if you have to carry purses, shopping bags, and other heavy items.
  • Don’t wear tight-fitting clothing, bracelets, or elastic bands around the access arm.
  • Do make a habit of sleeping on the non-access arm.
  • Don’t keep the access arm bent for long periods.
  • Don’t drive or operate heavy machinery until you are on prescription painkillers. 
  • Do avoid strenuous exercise and physical activity for the first 3 weeks after surgery.
  • Don’t soak or scrub the surgical site until it is fully healed.

What Are The Benefits And Risks of Dialysis Access Surgery?

Benefits

The benefits associated with dialysis access surgery include:

• It enables those with kidney failure to receive regular and necessary dialysis treatment. 
• It helps alleviate symptoms associated with kidney failure and improves the quality of life. 
• It facilitates dialysis, which prolongs survival. 

Risks

The risks associated with dialysis access surgery include:

• Anesthesia-related complications
• Bleeding
• Infection at the surgical site
• Scar formation
• Blood clots
• Narrowing of the blood vessels used for access
• Failure of access and need for revision surgery

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!