Dialysis is a medical procedure to remove toxins from the body. This procedure is performed when the kidneys are damaged and cannot function properly, for example due to kidney failure.
Dialysis (hemodialysis) for patients with kidney failure can be done in a hospital, in a dialysis unit that is not part of the hospital, or at home. Dialysis can be done with a variety of vascular access options. Each vascular access has its own advantages and disadvantages.
Blood vessel access for dialysis is a pathway that allows blood to be drawn from the patient's body and directly channeled into a dialysis machine. This access to blood vessels will then drain the filtered blood back into the patient's body.
Types of Access to Blood Vessels for Dialysis
There are 3 types of blood vessel access that can be used for dialysis, namely:
Arteriovenous (AV) fistula
An AV fistula is surgically created to create a connection between an artery and a vein. This access is usually made on the arm that is used less frequently. AV fistula is the type of access that is often chosen because it is considered effective and safe.
Even so, there are several conditions to perform AV fistula surgery, including the patient is not in an emergency condition, such as shortness of breath, and the patient has to wait 1-3 months after surgery until the connection between the artery and vein is "cooked". After that, dialysis can only be done.
Arteriovenous (AV) graft
AV graft is the preferred blood vessel access if the patient's condition does not allow for an AV fistula to be made, for example because the patient's blood vessels are too small. The surgeon can make connections between arteries and veins using a flexible synthetic tube called a graft.
AV grafts can be used 2-3 weeks after surgery. However, the duration of use of vascular access with an AV graft is shorter than that of an AV fistula.
Vein catheter (venous catheter)
A venous catheter is performed by inserting a tube into one of the large veins in the neck, groin, or chest. The surgeon will insert one end of the catheter into the vein and the other end outside the body.
Making access to blood vessels with a venous catheter is done with a minor operation. This access is often the first choice for patients who need immediate dialysis, for example in an emergency.
Venous catheter access has a number of disadvantages, including:
- Only temporary before surgery to create an AV fistula
- Needs replacement regularly
- Risk of causing infection (at access in the groin), blockage of blood vessels, or lung injury (at access in the chest)
Treatment After Vessel Access Surgery
If you have undergone surgery to create an AV fistula or AV graft, you will need to maintain the operated arm, ie by not lifting heavy weights and avoiding pressure on the arm while you are going to use the AV fistula or AV graft for dialysis.
In addition, maintaining a healthy lifestyle is also important because infection can occur more easily if you have a problem with your immune system or if you have been infected before.
After undergoing the procedure for inserting a venous catheter, you need to care for the venous catheter carefully, and make sure it is clean and safe to prevent the catheter from getting stuck, dislodged, or infected.
In special conditions, such as the COVID-19 pandemic, where planned (elective) surgeries such as AV fistulas and AV grafts are strictly limited and efforts are made to postpone, dialysis can still be performed with the installation of a temporary venous catheter.
If the venous catheter is blocked or infected, catheter replacement still needs to be done because dialysis should not be delayed.
If you still have dialysis questions during the COVID-19 pandemic, you can chat with doctors directly on the ALODOKTER application. You can also make an appointment for a consultation with a doctor at the hospital through this application if you really need a direct examination by a doctor.
Written by:
dr. Sonny Seputra, M.Ked.Klin, SpB, FINACS
(Surgeon Specialist)
