Vascular Access (for dialysis)

Publication Date: March 1, 2020

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the National Kidney Foundation (NKF) for vascular access for dialysis. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Dialysis is a medical replacement for kidney function. It can be done through a catheter (tube) placed into the abdomen (peritoneal dialysis) or by diverting blood flow from an artery through a dialysis machine and back into a vein (hemodialysis). Dialysis must be done regularly to remove toxic chemicals and excess fluid that kidneys normally excrete in the urine.
Several diseases such as diabetes and prolonged high blood pressure cause a progressive decrease of kidney function. When kidneys can no longer perform, their function must be replaced either by dialysis or transplantation.
Because dialysis may need to extend for years, major concerns are keeping the access open and preventing infection.
This patient summary focuses on establishing and maintaining vascular access to use for hemodialysis.

Diagnosis

If you have chronic kidney disease (CKD), your kidney function will decrease steadily and can be measured by a simple test called the glomerular filtration rate. As you approach a critical level, the NKF recommends that you and your treatment team establish an ESKD (end-stage kidney disease) Life-Plan to be reviewed annually. This deals with long-term plans for maintaining dialysis as well as preparation for kidney transplantation.
Additionally, NKF recommends that your dialysis access be frequently evaluated for signs of complications.

Treatment

Your kidney function may initially be replaced with peritoneal dialysis (PD), which can be performed at home once you have learned the procedure. You will receive both adequate training and frequent home visits to assure optimum results.
Peritoneal dialysis requires a catheter to be placed surgically into your abdomen. Special solutions are introduced, left for a few hours, then removed. During that time your peritoneum (the lining of your intestines) will discharge toxins into your abdomen that will drain out with the fluid.
Hemodialysis is a more direct method of cleansing your system while it removes toxins directly from your blood. For this, access to your blood vessels must be direct.
- There are three ways to access your blood vessels:
- Catheters can be placed into a large vein in your neck, arm, upper chest, abdomen, or groin (CVC).
- A surgical connection can be made between an artery and a vein either directly (arteriovenous fistula [AVF]) or with a graft (arteriovenous graft [AVG]).
To prevent infection, scrupulous infection control must be taken at all times and especially when establishing and handling the access devices.
Initial insertion of the access may be aided by ultrasound imaging.
Catheters, tubes, dressings, and all related supplies and equipment must also be handled with great care to prevent dislodging, kinking, breaking, or clotting.
Such precautions are required because of the long duration vascular access must be preserved and the limited number of alternative sites to re-establish it once a site ceases to function.
Antibiotics, antiseptics, and blood thinners can be used to prevent complications.
Access repair may be required using imaging techniques and surgical intervention.
Throughout the entire process, you will be an active participant in the multispecialty team making decisions and being thoroughly informed of treatment options, risks, and expected benefits.

Abbreviations

AVF: Arteriovenous Fistula
AVG: Arteriovenous Graft
CKD: Chronic Kidney Disease
CVC: Central Venous Catheter
ESKD: End-Stage Kidney Disease
NKF: National Kidney Foundation
PD: Peritoneal Dialysis

Source Citation

Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP; National Kidney Foundation. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020 Apr;75(4 Suppl 2):S1-S164. doi: 10.1053/j.ajkd.2019.12.001. Epub 2020 Mar 12. Erratum in: Am J Kidney Dis. 2021 Apr;77(4):551. PMID: 32778223.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.