What is Dialysis?
The kidneys filter blood in order to regulate electrolyte balance, keep or get rid of excess water and remove waste by producing urine. Kidney damage, also known as renal failure, results in improper filtering of blood. When renal failure becomes severe, toxic waste products and excess fluid build up and electrolytes become dangerously imbalanced which can lead to coma or even death.
Dialysis is the treatment for renal failure when the kidneys are too damaged to filter blood. The dialysis machine acts like an artificial kidney by removing toxic waste and excess fluid and regulating electrolyte balance. During dialysis, blood is temporarily removed from your body, passed through the dialysis machine and the purified blood from the dialysis machine is returned back to your body.
What are the Types of Dialysis Access?
There are two types of dialysis access positioned completely under the skin.They include:
- Fistula: created by connecting an artery to a vein. Arteries are strong tubes that carry blood down into your arm. Veins are smaller, more fragile tubes that carry it back to the heart. By connecting the artery to the vein, more blood comes through the vein and strengthens and stretches it.
- Graft: instead of making a direct connection between your artery and vein, a plastic tube can be used to connect an arter0y to a vein.
What are the Indications for a Fistula or Graft Access Procedure?
You may be a good candidate for a fistula if you have normal sized healthy veins. Fistulas are preferred because they can last longer and have fewer complications than grafts. However, some people are born with small veins that do not carry enough blood and cannot grow big enough to support a fistula. Others have veins that are scarred from prior procedures such as IVs. In such cases, a graft can be a useful procedure to create a long lasting and safe dialysis access.
Dialysis Access Maintenance FAQ
- Why do I need maintenance for my dialysis access?
Over time, a fistula or graft may develop areas of narrowing that slows down the flow of blood and makes it difficult to bring enough blood out into the dialysis machine. If the blood slows down too much, the fistula or graft may fill up with clot. Narrow areas can also increase the pressure inside the fistula or graft, leading to bleeding problems after the needles have been removed.
- How is my access checked?
If you develop one of these problems, you may be sent for an ultrasound which checks the amount of flow through your dialysis access and looks for areas of narrowing. If such a problem is found, you may be sent for a dialysis access angiogram, sometimes called a fistulogram or graftogram.
- What is a dialysis access angiogram, also know as a fistulogram or graftogram?
A dialysis access angiogram is a procedure that is done in our outpatient angiography suite adjacent to our office. The surgeon or interventional radiologist will use a balloon technique to stretch the fistular open. If there is clot present in the fistula, medications will be given through the tube to break up the clot.