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Mercy Dialysis Center

Types of Access for Dialysis

All dialysis patients have a surgically created access that connects an artery to a vein. The access allows the dialysis staff to access the blood system and perform the treatments. Without an access, dialysis could not be performed. An access usually is created during a same day surgical procedure (meaning you should be in and out of the hospital on the same day). The staff will educate you and your family on the care of your particular access. There are several different kinds of access:

  • Patient on Diaylsis Fistula – This access is the patient’s own artery connected to the side of one of their own veins. It usually is placed in the upper arm, but may be placed in the lower arm. The surgeon may do an x-ray to find the best vessel in which to create the access.
    • Advantages of a fistula
      • Patients’ own vessel. There is no foreign body.
      • Less swelling
      • Greater lifespan of the access.
    • Disadvantages of a fistula
      • Needs longer time to develop prior to using
      • May not develop in patients with vessel disease
      • Not for everyone based on vessel status.
  • Graft – This access is created by adding a piece of synthetic vessel to an artery on one end and a vein on the other. It is usually in the shape of a horseshoe or loop. It can be placed in the lower or upper army or the upper thigh. Patients with a graft are encouraged to learn which direction the graft flows and which side is considered the arterial and which is the venous.
    • Advantages of a graft
      • May be able to be utilized sooner. It does not need time to develop.
      • Can be used for patients who do not have good enough vessels for a fistula.
      • Higher blood flows are able to be obtained frequently.
    • Disadvantages of a graft
      • More swelling after surgery.
      • Potential for clotting.
      • Foreign substance in the body.
  • Central Line or Permcath – This access is a catheter that is tunneled in through the chest into the main blood vessel leading to the heart. There is no time needed for maturation or healing prior to use. These are placed either in surgery or in radiology with the assistance of an x-ray for placement. There may be some discomfort in placement.
    • Advantages
      • Immediate usability
      • No bleeding time after treatment
      • May be used for patients with very severe heart or vessel disease.
    • Disadvantages
      • Infection
      • Altered body image with access exposed outside of the body.
      • Not able to achieve as good blood flow rates.
      • Showering discouraged due to infection risk.
  • Life Sites – This access consists of two catheters placed under the skin with titanium ports for needle insertion. These are placed during surgery. There is no exposed catheter to care for and minimal dressing is required once healed in. There may be some tenderness of the sites after surgery, however, this should go away within a week. The staff performs dialysis through the sites. As the sites heal, these become easier to initiate treatment through.
    • Advantages
      • Immediate usability.
      • No tubing outside of the body to catch on.
      • Patient may shower.
      • Works well for those with vessel disease.
    • Disadvantages
      • Foreign substance in the body.
      • Discomfort for a few weeks
      • Infection
      • Potential clotting of the site.

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