Your Lifeline: Your Vascular Access

In order to facilitate haemodialysis, a vascular access is inserted into the body through a minor surgery—a fistula, graft, or catheter. Also known as “lifeline,” one of these accesses will be used to insert needles and connect kidney failure patients to dialysis machines. Feel free to consult with your doctor about the type of access that is best suited for you.

TYPES OF ACCESSES

Fistula

A fistula directly connects an artery to a vein. As the vein stretches and matures over time, your medical professional will be able to insert needles in your body and facilitate haemodialysis.

fistula

Advantages	Disadvantages
Permanent Beneath the skin Lasts longest Provides greater blood flow for better treatment Fewer infections & other complications Fewer hospitalizations	May not mature/develop Not possible for all patients Usually cannot be used for at least 6–8 weeks after placement

Graft

A graft is a tube, usually made of plastic, that connects an artery to a vein, which will allow your medical professional to insert needles and facilitate haemodialysis.

graft

Advantages	Disadvantages
Permanent Beneath the skin In some cases, it may already be used 2 weeks after placement May work for patients with poor veins	Increased hospitalizations Increased risk of clotting Increased risk of serious infections Increased risk of other complications and repair procedures Does not last as long as a fistula

Centre Veins Catheter

A catheter is a tube inserted into a vein at the neck or chest of the patient. The tip of the catheter rests at the heart. This is usually used as a temporary access and is the least preferred access into the bloodstream for haemodialysis.

centre-veins-catheter

Advantages	Disadvantages
Can be used immediately after placement	Higher infection rates, which can be very serious or fatal Increased hospitalizations Does not last long (usually less than one year) May require longer treatment times Prolonged use may lead to inadequate dialysis Patient will not be able to shower without special equipment High rate of clotting, which requires frequent procedures Risk of destroying important veins in the body

TAKING CARE OF YOUR VASCULAR ACCESS

Whichever type of access is chosen, it must be properly taken care of for safety and prevention of infections. Take note of these important points.

For Fistula or Graft

When the needles are removed at the end of treatment, you should apply pressure over the area to stop the bleeding. Hold this pressure for 10-15 minutes and then release it gradually. If there is bleeding, apply pressure directly to where the bleeding is.
We recommend that you carry around 4×4 gauzes with you all the time. They can be in your purse, car, or anywhere that is accessible to you. Use these gauzes to hold pressure when there is bleeding.
At home, it is vital that you keep your access clean. By keeping the skin around it sanitized, you can substantially reduce the risk of infection.

WHAT TO DO DAILY

PLEASE DO NOT:

Check your A-V access for signs of infection such as redness, swelling, soreness, warmness, or discharge.
Check your fistula if it’s properly functioning. To do this, place your fingertips over your access. Look for a pulse or thrill along the length of your fistula or vein to which your graft is attached.
Wash your A-V Access daily with soap and water.
You can take a shower and bathe normally.

Restrict blood flow through your A-V access for long periods. Be careful when lifting and carrying objects that may press against your fistula
Sleep on your A-V Access
Use your A-V access for the administration of any drug or medication without professional renal medical assistance
Wear tight jewellery over your A-V access
Allow lab draws or IV insertions in the arm of the A-V access
Allow your blood pressure to be monitored using the arm with A-V access

Call the dialysis centre when:

There is no buzzing sensation in your arm
There is pain or swelling in the arm
There are signs or symptoms of infection (i.e. drainage, tenderness, redness, or warm to touch)
There is substantial bleeding

For the Catheter

WHAT TO DO DAILY	PLEASE DO NOT:
Check for signs of infection, drainage, swelling, redness and soreness. Keep a dry dressing over the port ends. Cover your dressing with plastic wraps or baggies before showering. If the catheter comes out, apply pressure directly to the skin with the palm of your hand. You can also use any clean towel or washcloth.	Pull or tug the catheter Remove any sutures that are holding the catheter in place Allow usage of the catheter by anyone for IV or lab draws Remove any caps or take out any clamps on the catheter

Call the dialysis centre when:

There is drainage or discharge, pain, swelling, or redness around the access
You have fever
The catheter came out

TIPS FOR DEVELOPING AND MAINTAINING YOUR FISTULA

Exercising your arm daily may encourage the development and maintenance of your fistula’s health. Once your fistula is already matured and well developed, it is easier for the dialysis staff to place needles and facilitate your treatment. Below are some exercise techniques that may be used to help develop your fistula.