Dialysis Access Management
Providing Patients With Comprehensive Dialysis Access Management Service in a Comfortable and Convenient Setting
What is Dialysis Access
Management?
Dialysis access management refers to the process of planning and implementing the creation and maintenance of a reliable and long-lasting access point for hemodialysis.
Dialysis access refers to the point where blood is removed from the body for hemodialysis treatment. Dialysis is a lifesaving procedure for patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD), and it involves the use of a dialysis machine to filter and clean their blood. A stable and usable dialysis access is essential for efficient blood exchange during hemodialysis and to maintain the health and quality of life of patients with these conditions.
Why is Dialysis Access Management Important?
Effective dialysis access management is essential for a successful hemodialysis treatment. A stable and usable dialysis access ensures that a sufficient amount of blood can be removed and filtered during each treatment, leading to improved health outcomes and a higher quality of life for patients.
Moreover, a well-managed dialysis access can also reduce the risk of complications such as infection, bleeding, and stenosis, a condition in which the access narrows and blood flow is restricted. Proper access management can also extend the lifespan of the access, reducing the need for frequent access revisions and surgeries.
Creation of Dialysis Access
After planning and preparing for the hemodialysis treatment, the next step is to create the dialysis access, meaning that an access into the bloodstream must be established. A central venous catheter (CVC), an arteriovenous fistula (AV fistula) or an arteriovenous graft (AV graft) are the three most common types of accesses used for hemodialysis. Peritoneal dialysis is another procedure that requires a different type of access known as a peritoneal dialysis catheter (PD catheter).
Central Venous Catheter (CVC): CVC is a type of vascular access that comprises a flexible, long, plastic, Y-shaped tube. During the procedure, a small incision is made in the patient’s neck, chest or groin to gain access to your bloodstream. Then using a guided wire, the tube is inserted through the skin into a central vein. This procedure is necessary if the patient is in need of immediate or emergency dialysis treatment.
Arteriovenous Fistula (AV Fistula): AV fistula is a surgical connection established between an artery and a vein. It is usually located in the arm, but can be placed in the leg if needed. The AV fistula diverts blood from the artery into the vein, increasing blood pressure and flow. This leads to the enlargement of the veins, allowing them to provide sufficient blood flow for hemodialysis. AV fistulas are the preferred choice for long-term dialysis due to their longevity, low risk of infection and clotting, and consistent performance. It does, however, take several months for the connection to mature before it is used for dialysis.
Arteriovenous Graft (AV Graft): An AV graft works for patients whose veins are too weak or thin to support an AV fistula and for those who need dialysis urgently. It is typically situated in the arm, but can be positioned in the leg if necessary. The AV graft involves the connection of an artery and vein using a synthetic, hollow tube. One end of the tube is attached to an artery while the other end is connected to a vein. Blood flows from the high-pressure, high-flow artery, through the graft and into the low-pressure, low-flow vein. This results in a blood flow rate that is sufficient for an effective hemodialysis treatment. An AV graft will also need 3-4 weeks to heal before using it for dialysis treatment.
Peritoneal dialysis catheter (PD catheter): Peritoneal dialysis is different treatment from hemodialysis. Before receiving this treatment, patients need to have a PD catheter for this dialysis access. In contrast to hemodialysis, where blood is removed from the body, peritoneal dialysis (PD) utilizes the peritoneal membrane in the abdomen and a dialysate solution to cleanse the bloodstream of toxins that the kidneys are no longer able to remove.
Dialysis Access Dysfunction
If a patient’s dialysis access is not operating effectively during the treatment, it may be necessary to undergo dialysis access interventions, such as a fistulogram, angioplasty, stent placement, or declot procedures, to bring back the normal blood flow in the access.
Fistulogram: If an AV fistula or AV graft is not working optimally during hemodialysis, a fistulogram may be carried out. This is a minimally invasive x-ray procedure that uses IV contrast to visualize the access and detect any areas where the blood vessel is narrowed (stenosis), abnormally enlarged (pseudoaneurysm), or obstructed (clotted).
Angioplasty: If abnormal narrowing in the blood vessel is detected during the fistulogram, then it can be treated with an angioplasty, which is a minimally invasive procedure that uses a catheter with an inflatable balloon to widen the narrowed blood vessel in order to restore blood flow.
Stent Placement: It is a minimally invasive procedure that is sometimes used together with angioplasty. The stent placement is only needed if the angioplasty is not successful in keeping the narrowed blood vessels open, and it remains in the vessel to improve blood flow.
Declot Procedure: A declot procedure is a standard dialysis access management treatment that is performed when either a fistula or a graft becomes partially or completely clogged. Minimally invasive procedures, such as a thrombolysis (medication injected directly into the clot to dissolve it) and thrombectomy (using catheter to remove blood clot), can be utilized to eliminate the blockage from the access point to restore proper blood flow.
Steps Involved in Dialysis Access Management
Planning and Preparation: The first step in dialysis access management is to assess the patient's suitability for hemodialysis and determine the best type of access for their needs. This may involve consultation with a nephrologist, a surgeon, and a vascular access specialist.
Creation of the Access: The next step is to create the dialysis access, which may involve surgical procedures such as AV fistula, AV graft placement or CVC.
Maintenance and Monitoring: After the access is created, it is essential to monitor and maintain it to ensure it remains usable and stable. This may involve regular ultrasound scans, blood flow measurements, and dressing changes to prevent infection.
Management of Complications: In some cases, dialysis accesses may develop complications such as stenosis, infection, or thrombosis (blood clots). It is crucial to detect and treat these complications promptly to prevent further damage to the access and maintain its usability.
Revision and Replacement: Over time, dialysis accesses may become stenotic, infected, or non-functional. In such cases, a revision or replacement procedure may be necessary to restore access patency and maintain its usability.
Dialysis Access Management at Indiana Vascular
Our team of medical professionals is committed to providing compassionate and personalized care to our patients. We understand the challenges that come with undergoing dialysis treatment, and we are here to support our patients throughout the process. We provide a comfortable and welcoming environment that puts our patients at ease and helps them feel more relaxed during their treatment.
At Indiana Vascular, we prioritize patient comfort and convenience in every aspect of our dialysis access management. We strive to provide a comprehensive service that meets the unique needs of each patient, ensuring their safety and well-being during their dialysis treatment.
If you or a loved one is in need of dialysis treatment, schedule an appointment with us today to receive a free consultation and gain insight on our services, as well as experience our high-quality care firsthand.