Patient education: Arteriovenous vascular access for hemodialysis (The Basics)

What is hemodialysis? — Hemodialysis is a treatment for kidney failure. Normally, the kidneys work to filter blood and remove waste and excess salt and water. Kidney failure, also called "end-stage kidney disease," is when the kidneys can no longer filter blood properly.

With hemodialysis, a machine takes over the job of the kidneys. The machine pumps blood out of the body, filters it, and returns it to the body (figure 1). People have hemodialysis at least 3 times a week.

What is arteriovenous vascular access? — "Arteriovenous" ("AV") means connecting an artery to a vein. "Vascular" means related to the blood vessels. "Access" means a way to get in.

An AV vascular access is a way for blood to leave and return to your body during hemodialysis. Your doctor will do surgery to create an access under your skin, usually in the lower part of your arm. An access needs time to heal before it can be used.

There are different types of AV access:

●AV fistula – Most people get this type of access (figure 2). To make this access, a doctor does surgery to connect an artery directly to a vein. An AV fistula needs to heal for 2 to 4 months or more before it can be used for dialysis.

●AV graft – To make this type of access, a doctor uses a plastic tube to connect an artery to a vein (figure 3). An AV graft usually needs to heal for 2 weeks before it can be used for dialysis. Some can be used after a couple of days.

How do I prepare for surgery? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get an ultrasound or other imaging tests to see which blood vessels have the best size and blood flow. (Imaging tests create pictures of the inside of the body.)

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any other kind of vascular access you might have had – This includes if you had any "central venous catheters" for hemodialysis or for any other reason.

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might be asked to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during surgery? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make a small cut over the blood vessels. Or they might use a needle to access the blood vessels.

●Then, the doctor will join the artery and vein together to create the access. They might connect the blood vessels directly or use a small plastic tube to connect them.

●The doctor will close your cuts (incisions) and cover them with clean bandages.

●The access can be used for dialysis within days to months. This depends on the type of access you have.

What happens after surgery? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people can go home the same day.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of vascular access? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Swelling in the hand or arm

●Access not having good blood flow or not fully healing

●Infection

●Decreased circulation in the hand

What follow-up care do I need? — Your doctor or nurse will tell you when you need to make a follow-up appointment. Make sure that you know when and where to go.

When should I call the doctor? — Call for advice if:

●You have symptoms of infection. These include a fever of 100.4°F (38°C) or higher, chills, and color changes, drainage, warmth, or pain over the access.

●Your arm or hand is tingling, feels numb, or is pale or cold.

●You have bleeding from your access that does not stop with gentle pressure.

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Hemodialysis (The Basics)
Patient education: Hemodialysis catheter placement (The Basics)
Patient education: Preparing for hemodialysis (The Basics)
Patient education: Peritoneal dialysis (The Basics)
Patient education: Dialysis and diet (The Basics)
Patient education: Chronic kidney disease (The Basics)

Patient education: Hemodialysis (Beyond the Basics)
Patient education: Peritoneal dialysis (Beyond the Basics)
Patient education: Chronic kidney disease (Beyond the Basics)