Various Blood Vessel Access Options for Dialysis

Dialysis is a medical procedure for removing toxins from the body. This procedure is done when the kidneys are damaged and cannot function properly, for example, due to kidney failure.

Dialysis (hemodialysis) for patients with kidney failure can be done in the hospital, in a dialysis unit that is not part of the hospital, or at home. Dialysis can be done with a variety of blood vessel access options. Each blood vessel access has advantages and disadvantages of each.

Access to blood vessels for dialysis is a pathway that allows blood to be drawn from the patient's body and directly distributed to the blood washing machine. This blood vessel access will then drain filtered blood back to the patient's body.

Various Types of Access to Vessels for Dialysis

There are 3 types of blood vessel access that can be used for dialysis, namely:

Arteriovenous (AV) fistula

AV fistula is made through surgery to make a connection between arteries and veins. This access is usually made in the arms that are used less frequently. AV fistula is the type of access that is often chosen because it is considered effective and safe.

Even so, there are several conditions to perform AV fistula surgery, including patients not in an emergency condition, such as tightness, and patients must wait 1-3 months after surgery until the connection between the arteries and veins is "mature". After that, dialysis can only be done.

Arteriovenous (AV) graft

AV graft is the access of the selected vessels if the patient's condition is not possible to make an AV fistula, for example, because the patient's blood vessels are too small. The surgeon can make the connection between the arteries and veins using a flexible synthetic tube called a graft.

AV graft can be used 2-3 weeks after surgery. However, the time period for using vascular access with AV graft is shorter than that of AV fistula.

The vascular catheter (venous catheter)

A vein catheter is performed by inserting a tube into one of the large veins in the neck, groin, or chest. The surgeon will insert one end of the catheter in the vein and the other end of the catheter is outside the body.

Making access to blood vessels with venous catheters is done by minor surgery. This access is often the first choice for patients who need immediate dialysis, for example in an emergency.

Venous catheter access has a number of disadvantages, including:

• Only temporarily before surgery to make AV fistula.
• Need regular replacement.
• Risk of causing infection (in access to the groin), clogging of blood vessels, or lung injury (in access to the chest).

Treatment After Surgery Access Vascular

If you have undergone surgery to make an AV fistula or AV graft, you need to keep the arm operated on, by not lifting heavy loads and avoiding pressure on the arm as long as you will use an AV fistula or AV graft for dialysis.

In addition, maintaining a healthy lifestyle is also important because the infection can more easily occur if you have a problem with your immune system or if you have been infected before.

After undergoing a vein catheter procedure, you need to treat the vein catheter carefully and make sure it stays clean and safe to prevent the catheter from getting clogged, detached, or infected.

In special conditions, such as the COVID-19 pandemic, where planned (elective) operations such as AV fistula and AV graft are severely restricted and attempted to be postponed, dialysis can still be done with temporary venous catheter placement.

If the vein is clogged or infected, it is still necessary to replace the catheter because dialysis should not be delayed.

If you still have dialysis questions during the COVID-19 pandemic, you can chat directly with the doctor.

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