Vascular Access

Patients who have developed kidney failure require dialysis to maintain their health. Dialysis removes the impurities and fluid from the bloodstream that is normally removed by the kidneys. Dialysis can be administered in the abdominal cavity (peritoneal dialysis) or via the circulation (haemodialysis). Your renal physician and dialysis nurse will discuss with you the best modality to start dialysis with.

Peritoneal dialysis is administered via a peritoneal dialysis (Tenckhoff) catheter. This is inserted into the abdominal cavity via a small incision under general anaesthesia. In suitable candidates it may be inserted under local anaesthesia using a minimally invasive technique. Fluid is inserted into the peritoneal cavity and is regularly exchanged in order to remove impurities and fluid from the circulation.

There are 3 methods of receiving haemodialysis:

  1. Via a tube inserted in a large vein in the neck or leg (vascath)
  2. Via a vein connected to an artery - Arteriovenous (AV) fistula
  3. Via a plastic tube connected to an artery and a vein - Arteriovenous (AV) graft

If you are planning to commence haemodialysis, it is important that you protect one of your arms, as damage to the veins from blood tests, drips and blood pressure measurement can prevent the vein from being used to create a successful fistula.

While vascaths can be used to urgently commence dialysis, it is preferable to avoid them in the longer term due to the risk of infection, blockage and damage to the large veins where they are inserted.

If your own veins are an adequate size and quality it is preferable to create an AV fistula. Usually these are created at the wrist, but other configurations may be required.

The fistula requires time to enlarge or mature before it can be used for dialysis. Hence it is preferable for your renal physician to refer you for creation of a fistula long before it is required for dialysis, to allow time for maturation to occur. Other operations may be required to assist with maturation.

If your own veins are not suitable for fistula creation a plastic tube or prosthetic graft can be used to allow access for haemodialysis. An operation is performed to connect the graft to an artery and vein in the arm or leg. The graft can be used almost immediately for dialysis but in the longer term grafts tend to have more problems than fistulae.