Condition - Dialysis Access

What Is
Dialysis Access?

If your kidneys fail, unless and until you have a successful kidney transplant, you will need dialysis therapy to clean and filter your blood. The first step is establishing dialysis access one of four ways:

  1. A tunneled catheter in your neck—temporary, because the possibility of infection is high.
  2. An AV fistula—taking a piece of a vein from your arm or leg and sewing it into a nearby artery, and allowing the sewn-in vein to enlarge and become thicker, like an artery. Considered the best option because it has the lowest risk of infection.
  3. An AV graft—the sewing of a prosthetic graft between an artery and vein in your arm or leg. The preferred option if your veins are too small for an AV fistula. AV grafts tend to close more quickly and are more prone to infection because they are not formed from natural tissue.
  4. Peritoneal dialysis—placement of a small tube, called a cannula, in your abdomen to allow the use of the lining of the abdomen (peritoneum) to filter your blood. It requires several “exchanges” every day: you introduce and remove fluid through the tube. A convenient option because you perform the dialysis therapy at home, but infections sometimes occur and the tube can become clogged.

Dialysis Methods

Dialysis Access Cape Town | Mouton Vascular

Peritoneal Dialysis Catheter Insertion

Peritoneal dialysis differs from hemodialysis, you can give yourself treatments at home, at work or while traveling.

With peritoneal dialysis, a catheter is inserted into the abdomen and left there. In the comfort of your home, you will be able to administer the peritoneal dialysis treatment yourself by using the catheter to fill the abdomen with dialysate and letting it sit there for a period of time. Once the time has elapsed, you can drain the fluid and replace it with fresh dialysate.

Dr. Mouton is able to surgically place the catheter tubing into the abdominal cavity so that the dialysate can be instilled and drained with ease.

Dialysis Access Cape Town | Dr JP Mouton

Permanent hemodialysis catheters

For patients who receive long term dialysis, a permanent catheter may be placed in order to allow ease of access to the bloodstream.

The catheter is a long, flexible tube that is inserted into a vein, most commonly in the neck (internal jugular vein) and less commonly in the groin (femoral vein). This type of catheter is tunneled under the skin for a few centimeters. Tunnelling the catheter under the skin decreases the risk of infection, allowing it to stay in place for as long as a year before it needs replacing.

These tunneled catheters provide permanent access in patients who require long term dialysis. Despite being considered permanent, the longer they are in place the greater the risk that they will eventually become infected. This is why most physicians will try to use these catheters as a bridge whilst finding other means of even more permanent dialysis such as an arteriovenous fistula or graft.

Formation of AV Fistulas | Vascular Surgeon Cape Town

Formation of AV Fistulas

A fistula (also called an arteriovenous fistula or A-V fistula) is made by joining an artery and a vein under the skin in your arm. When the artery and vein are joined, the pressure inside the vein increases, making the walls of the vein stronger. The stronger vein can then receive the needles used for hemodialysis.

Dr. Mouton prefers fistulas because they provide good blood flow and generally last longer than other types of access. Because a fistula is created from your artery and vein, it is a natural part of your body.

An A-V fistula usually takes 3 to 4 months to heal before it can be used for hemodialysis, and can be used for many years in patients that require long term dialysis. The A-V fistula procedure is an outpatient procedure, so you will be able to recover at home after the procedure.

Fistula’s are the first option for Dialysis Access because:

  • It has a lower risk of infection
  • It has a lower tendency to clot
  • It allows for greater blood flow and reduces treatment time
  • It stays functional longer than other access types
  • It’s usually less expensive to maintain

While the AV fistula is the preferred access, if the vascular system is severely compromised a vistula may not be the best access option. Dr. Mouton will go through all the options available with you and advise on the best method of accessing the bloodstream for Dialysis.

Dialysis Access Cape Town | Salvage of Failing AV Fistulas

Salvage of failing AV fistulas

Numerous studies have shown that the native arteriovenous fistula (AVF) has better long-term outcomes than other forms of access for hemodialysis. However, complications may require challenging salvage procedures.

Dr. Mouton is able to efficiently salvage failing AV fistulas, ensuring that they become functional once more. This prevents the need to create additional AV Fistulas for dialysis access, which means that you will not need to go through the fistula maturation process or make use of a catheter during this process.