Vascular Access
Possible options for vascular access placements.
If you have any questions or concerns, please contact your primary nephrologist’s office and ask to speak with your Vascular Access Care Coordinator.
Fistula
A fistula directly connects an artery to a vein. The vein stretches over time, allowing needles to be put in it. Fistulas are the best way to get access to the bloodstream for hemodialysis.
Advantages
- Permanent
- Beneath the skin
- Safe to shower & swim
- Lasts longest, up to 20 years
- Provides greater blood flow for better treatment
- Low chance of infection
- Fewer hospitalizations
- Better survival (lower risks of patients dying than patients with catheters)
Disadvantages
- Takes time to mature/develop
- Usually cannot be used for at least 6-8 weeks
- Not possible for all patients
Graft
A graft is a tube, usually made of plastic, that connects an artery to a vein, allowing needles to be put in it. Grafts are the second-best way to get access to the bloodstream for hemodialysis.
Advantages
- Permanent
- Beneath the skin
- May be used after 2 weeks, in some cases.
- Safe to shower & swim
Disadvantages
- At risk for clotting
- Increased chance of infections
- Increased risk of hospitalizations
- Increased risk for other complications and repair procedures
- Grafts last for a shorter time than a fistula
Catheter
A catheter is a tube inserted into a vein in the neck or chest. The tip rests near your heart. It is usually a temporary access. For some people, it is the only option and it will need to be used as permanent access.
Advantages
- Can be used immediately after placement
Disadvantages
- Increased risk of death
- Highest risk of serious infection
- Increased hospitalizations
- May require longer treatment times
- Prolonged use may lead to inadequate dialysis
- Cannot shower without special appliance. No swimming.
- High rate of clotting requiring frequent procedures
- Risk of central vein narrowing (can lead to other problems)
Peritoneal Dialysis Access
The PD Catheter is usually made of a soft silicone rubber tubing that is easily concealed under your clothing.
Advantages
- Fewer diet & fluid intake restrictions
- Flexible treatment schedule
- Eliminates routine needle sticks
- May extend kidney function longer
Disadvantages
- Requires you to maintain healthy PD access in abdominal cavity
- Requires you to perform treatments every day
- Need storage space for supplies