What are the various types of Dialysis or Hemodialysis Vascular Access?

Clearing the blood of built-up waste products and excess water in patients with chronic kidney disease (CKD) requires the ability to access the affected patient's blood stream. The blood is passed through a filter and then given back in a more purified form to the patient.

A stable form of access to the patient's blood stream is one critical key to successful dialysis. The access is usually called vascular (meaning blood vessel) access.

The table below lists the various types of widely employed access types.

First, two definitions:

A catheter is a thin hollow flexible tube that allows fluids to flow.

A fistula is a passageway between two different body parts or the inside and outside of the body.

Dialysis and Hemodialysis Access Types

A fistula uses the patient's own tissue to connect an artery and vein,
usually in the forearm.

A graft connects an artery to a vein using a piece of synthetic tubing. Grafts take less time to 'develop', so they can sometimes be used earlier for dialysis, but dialysis grafts may be subject too more clotting and infection rates than dialysis fistulas.
Peritoneal Catheter
Usually a plastic catheter than is surgically implanted to allow the dialysis cleansing fluid (dialysate) to enter and leave the peritoneal cavity.
In peritoneal dialysis, there is no direct connection to the blood stream.

Temporary Dialysis Catheter

A short term solution for emergency dialysis or while waiting for a dialysis fistula or graft to be ready. These are temporary central venous catheters or CVC which is a plastic tube or catheter placed into the main vein in the neck or chest.
A stent graft is used to open and help keep open a blocked dialysis fistula.
Hemodialysis Fistula Access: Buttonhole versus Rope and Ladder Technique
Hemodialysis Vascular Access Type and Bloodstream Infection Rates

Eduardo K. Lacson, Weiling Wang, J. Michael Lazarus, Raymond M. Hakim. Fresenius Medical Care, North America, Waltham, MA
November 19, 2010  

Introduction: We evaluated bloodstream infection (BSI) rates based on positive blood cultures by type of vascular access in a national cohort of incident hemodialysis (HD) patients during their first year.

Patients' Perspectives of Constant-Site (Buttonhole) Cannulation for Haemodialysis Access.

Nephron Clin Pract. 2010 May 21;116(2):c123-c127.
Ward J, Shaw K, Davenport A.
Barnet Dialysis Centre, Royal Free Hospital, London, UK.



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