If you are getting treatment for kidney dialysis in the upcoming months, you should work with the health professional team to know about the performance of the treatments and how to receive the maximum benefit from them. One necessary step prior to begin kidney dialysis programmes regularly is getting ready for vascular access, that is the area on the body where blood is removed and come back at the time of dialysis. To optimize the level of blood purified at the time of kidney dialysis treatment, the vascular access must let large amounts of blood flow regularly.
The vascular access must be prepared weeks or months before you begin dialysis. This arrangement of the vascular access will allow for easier and better replacement and removal of the blood with some less complication.
The three traditional types of vascular access for kidney dialysis are an arteriovenous graft, an arteriovenous fistula and a venous catheter.
What is an Arteriovenous Fistula?
A fistula is a connection or opening between two parts of the body which are generally separate like a hole in the tissue that usually separates the bladder from the bowel. Most of the types of fistula can cause problems but an AV fistula is beneficial because it creates the vein to develop bigger and stronger for accessing to the blood system easily. This fistula is regarded the effective long term vascular access for this treatment because it offers required amount of blood flow, lasts for more time and contain a reduced complication level than other kinds of access. If the AV fistula cannot be made, venous catheter or an AV graft may be required.
An AV fistula needs prior planning because it takes some time after surgery to grow. But a planned made fistula is less likely than other types of vascular access to become infected or make clots. Properly done fistulas like to last more years than any other type of vascular access.
A vascular specialist makes an AV fistula through attaching an artery straightly to a vein, often in the forearm. Attaching the artery to the vein creates huge amount of blood to flow in to the vein. So the vein develops bigger and stronger, creating continuous needle inclusions for making the treatment easier. For the surgery, you will be provided a local anesthetic. Mostly the treatment can be done on the outpatient basis.
What is an Arteriovenous Graft?
If you have little veins that will not grow properly into a fistula, you can receive a vascular access that links an artery to a vein availing a synthetic graft, tube, implanted on the skin in the arm. The tube or graft turns as an artificial vein which can be availed regularly for needle insertion and blood access at the time of treatment. A graft does not want to grow like a fistula performs; hence it can be availed immediately after placement usually within seven or twenty-one day.
When compared to prior made fistulas, grafts are more likely to have problems with infection and clotting and require replacement quickly. But a properly cared for graft can serve for many years.
What is a venous catheter for short term access?
If the kidney disease has developed, you may not get the time to receive a permanent access prior you begin the treatment. You may want to use a venous catheter for a short term access.
A venous catheter is a tube placed in to a vein in the chest, neck or leg close to the groin. It contains two chambers to let a two side flow of blood. After the catheter is inserted, needle placement is not required.
Catheters are not perfect for long term access. Catheters can become infected, clog and lead to narrowing of the veins. But when you want to begin the treatment immediately, a catheter will perform for more weeks or months when the long term access grows.
For few people, graft or fistula is ineffective and they require availing a permanent catheter access. They will be required for above up to 21 days are made to be tunneled on the skin to raise comfort and lessen complications. Even these are sometime prone to infection.
What are the likely difficulties of vascular access?
The above mentioned three types like AV graft, AV fistula and venous catheter can contain complications that need further surgery or treatment. The common difficulties are low blood flow because of blood clotting in the access and access infection.
Venous catheters are prone to infection and clotting issues which may need medication and catheter replacement or removal.
AV grafts can later lead to low blood flow, a sign of narrowing of the access or clotting. In this condition, the AV graft may need angioplasty, a treatment to widen the tiny segment that is narrowed. Another choice is to do surgery on the graft and also replace the segment.
Low blood flow and infection are less common in perfectly made AV fistula than these two methods. But still containing an AV fistula is not an assurance against complications.
Latest Technology for Kidney Dialysis
Our doctor uses a new technology called drug eluting balloons, that were introduced to Singapore and approved by Health Science Authority in 2010. Dr Cheng Shin Chuen is one of the more aggressive surgeons in Singapore using these balloons for kidney dialysis. The results have been very positive on our patients thus far, with the blockage opening for at least nine to ten months, compared to two to three months in the past.
Contact our vascular surgeon for a comprehensive consultation to determine which type of vascular access is most suitable for your health conditions.