fistula

In order for a patient to undergo dialysis treatment they must be connected to a machine that filters their blood. The machine gets blood from one of the patient’s arteries and returns it through one of their veins. The spot on the patient’s body where the tubes connect to the artery and vein is called the access. This access point offers an easy and convenient entrance to the patient’s body and is not removed between treatments. There are three points of access for hemodialysis: graft, fistula and catheter. There are pros and cons to each point of access and the supervising doctor will explain options to each individual and help decide the best one.

Although each point of access has it pros and cons, most medical professionals agree that the best of the three is the fistula. The reason the fistula is the preferred method is because it typically lasts for a longer period of time and produces fewer complications such as infections and clotting. Creating this access point requires minor surgery so it is best to have it placed at least a few months ahead of when the dialysis is scheduled to begin. This allows the fistula plenty of time to settle and be ready for use and also gives the patient time to heal before treatment begins. Creating a fistula access involves connecting one of the patient’s vein to a close by artery. This is usually done in the elbow or wrist. Doing this makes a good sized blood vessel which allows the blood to flow faster. This point of access typically lasts for many years.

The next most popular point of access is the graft. Like with the fistula, minor surgery is required. The procedure involves putting artificial tubing into a vein and a close by artery. A graft is typically put in the upper part of the arm or the bend of the arm; however, it can also be placed in the chest wall or the leg. Where it goes will be decided by the patient’s doctor. Unlike the fistula, a graft only needs to be put in about two weeks prior to beginning hemodialysis treatment. Grafts have more problems with clothes and infections but if well cared for can last several years.

Last of all is the catheter. This point of access is most commonly used when there is only a temporary need for access. For instance, for someone who must start dialysis immediately, a catheter may be used while the fistula or graft matures for proper use. Sometimes it is used for a longer period of time because a graft or fistula is not possible for some reason. Catheters are made of soft, plastic tubing and consists of two parts. One serves to remove the blood while the other returns it to the patient’s body once it is cleansed. They are generally put into the neck but can also be placed in the upper part of the chest.

Fistula Pros and Cons:

Pros-

  • Less chance of infection

  • Able to stay in place for long periods of time

  • Gives an excellent source for blood flow

  • Not likely to develop blood clots

  • Patients can take showers after the surgical wounds heal up

Cons-

  • Takes longer to heal and be ready for use than other points of access

  • Needles must be used to connect the patient to the dialysis machine

Graft Pros and Cons:

Pros-

  • Gives an excellent source for blood flow

  • Patients can take showers after the surgical wounds heal up

  • Heals faster than a fistula

Cons-

  • Does not last as long as a fistula does

  • Chances of infection are higher than with a fistula

  • Problems with clotting are common

  • Needles must be used to connect the patient to the dialysis machine

Catheter Pros and Cons:

Pros-

  • Can be put to use immediately upon insertion

  • Needles are not needed in order to connect the patient to the dialysis machine

Cons-

  • Access is temporary

  • More prone to infection

  • May cause a narrowing of patient’s blood flow vessels

  • Prone to developing blood clots

  • Patient cannot take a shower without covering the catheter with protective gear

Each situation is different and the placement of each patient’s access will depend on their medical professional’s determination of the best choice.