Patients with end-stage renal disease (ESRD) receive hemodialysis treatment. Dialysis is a medical process that removes waste and extra chemicals and fluid from a person's blood. During dialysis, blood goes into a needle and travels through a tube into a dialyzer. Once the blood is in the dialyzer, it flows through thin fibers. These fibers filter out wastes and extra fluid. Once completed, the blood travels through the machine and back into the patient. This process continues until the end of the dialysis treatment.
An arteriovenous (AV) fistula is a surgical connection between an artery and a vein. In the body, arteries carry blood from the heart to the rest of the body. Veins carry blood from the body back into the heart. During the surgical procedure a vascular surgeon places the AV fistula in the forearm or upper arm. The fistula causes extra pressure and blood to flow into the vein, making the veins grow larger and stronger. The larger vein creates easier access to blood vessels. Without an AV fistula, veins would not be able to withstand the continuous insertion of needles. This would eventually lead to the collapsing of the vein.
Health care providers recommend AV fistulas over other vascular accesses because:
AV Fistulas provide strong blood flow for dialysis
AV Fistulas have a longer life than other accesses
AV Fistulas are less likely to get infected or cause blood clots
Venous Catheter
A venous catheter is a tube that is placed directly into a vein through either the neck, chest, leg or groin. When the catheter exits the body a tube is split in two. The two tubes have caps designed to connect to the line that carries blood to the dialyzer. They are also the lines that carry blood from the dialyzer back to the body. A person must close the clamps on each line when connecting and disconnecting the catheter from the tubes. Catheters are usually used for temporary dialysis. In most cases, catheters are used while an ESRD patient is waiting for their AV graft or fistula to heal. Catheters are not the best alternative for long-term use because catheters are prone to infections and clotting. Additionally, venous catheters may cause scarred veins resulting in narrowed veins.
Arteriovenous (AV) graft
An arteriovenous graft is a surgically implanted looped plastic tube that connects an artery to a vein. This procedure can be done in an outpatient setting but the patient may have to stay overnight in the hospital. The AV graft usually takes 2-3 weeks to heal after surgery. The graft has a greater likelihood of acquiring an infection and clotting. When clotting continuously occurs, blood flow may be blocked through the graft. However, if the patient and the dialysis facility diligently tend to the graft it can last for several years.
