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Saturday, 08.08.2020, 06:16
Main » Vascular surgery » Hemodialysis access 
15:45
Hemodialysis access


What is Hemodialysis Access?

Hemodialysis access is a device that gives access to the bloodstream the patient, which is located under the skin. Typically, access is on the arm or leg, and allows you to quickly, safely and effectively connect to the machine gemodiliaza.

Hemodialysis is used primarily for the treatment of renal failure. Hemodialysis machines ("artificial kidney") is intended to remove from the blood of the patient's metabolic products. During the procedure, the doctor uses a dialysis access for hemodialysis blood through a machine. Function of the apparatus is to be derived from blood metabolites and regulate the chemical balance of the plasma. After that, purified blood returns to the bloodstream through the Hemodialysis Access.

Creation of access - the port is a small operation. There are two types of ports:
Fistula - a connection with the artery vein
Stent - an artificial tube, which connects the artery with a vein

When used as a fistula and the stent, the connection between the artery and vein increases the volume of blood flow through the vein. In response, the Vienna stretches and becomes elastic. Through this vein passes through a larger volume of blood that increases the effectiveness of hemodialysis.

A week after the operation, the fistula begins to "ripen." It increases in size may seem like a cord under the skin. The whole process usually takes 3 - 6 months. Sometimes this process takes up to one year, but this rarely happens. Matured fistula should be broad and sufficiently flexible to be able to easily enter into it dialysis needles. If the maturation of the fistula does not occur, then put another fistula.

The stent can be used in 2 - 6 weeks after it happens engraftment. Generally preferred fistula, since its formation are used patient's own tissues, which are more resistant to infection than the stent. However, the blockage of veins or small diameter of the stent preference.

Preparing for the hemodialysis access


Before you choose a location for the hemodialysis access surgeon discovers the presence of a patient of any disease of the arteries of hands and feet. This is due to the fact that the Hemodialysis access is not established in that part of the body where blood flow is violated. Consequently, access to dialysis is chosen most often in the hands as feet often affected artery atherosclerosis. Before installing the fistula vein doctor also examines the patient (using ultrasound or venography).

For 8 hours before surgery is recommended to refrain from taking food and water. If you are taking any medications, you should consult on this matter with your doctor.
Indications for the installation of access for hemodialysis

Installation of hemodialysis access for patients with chronic renal failure requiring hemodialysis.

If you have a small diameter veins or because of the frequent use of intravenous catheters or needles they sraslis, then you probably advisable to install a stent.

In addition, the fistula is not suitable for patients with significant narrowing of the arteries. In the presence of infection in the proposed installation hemodialysis access fistula is preferred, since the stent can become infected.
The installation procedure hemodialysis access

Most often, surgery is performed under local anesthesia, but if necessary - under general anesthesia. The operation consists in connecting an artery and large vein under the skin of the hands (or feet). The surgeon makes incisions in the artery and vein and sews them together. As a result, blood flows from the vein as well as in the arteries. Therefore, blood flow to your hands does not suffer.

When a small amount of venous occlusion or the surgeon uses a stent made of synthetic material. Rarely used for this purpose a piece of vein from the leg or artery of a cow. The surgeon sutured the stent in one of the veins and connects the other end with the artery. The stent is usually in the form of a loop is installed underneath the skin of the hands, sometimes feet.

What can I expect after installing the hemodialysis access?


After surgery, the patient should have a place hemodialysis access above the heart to prevent the occurrence of swelling and pain. Observe the following recommendations:
Keep in dry place cut at least two days after surgery and do not comb it until it heals
 Do not lift the weight more than 7 kg and limit physical activity, in which there may be pressure on the area of operations
Immediately report your doctor if you experience pain, swelling, or bleeding from the surgical site.

In the early after surgery may feel some numbness or cold hands. Usually these feelings pass within a few weeks, as will the compensation of blood supply in the hand. However, if these feelings persist or become worse, tell your doctor, as the fistula may decrease blood flow to the hand. This phenomenon is called a "steal." You have to do exercises to strengthen the fistula. To do so, his hand on which a fistula, compress and decompress any soft object.

Stent catch on much faster than the fistula, depending on the size of the veins. Sometimes healing takes 2 - 3 weeks, but more often than your doctor advises to wait 4-6 weeks before the start of the stent.

Stents are more prone to infection than a fistula. The duration of the stent is 1-2 years, which is less of a fistula. Their useful life is 3 - 7 years. However, the stent can also be used for a long time, with proper care for them. Sometimes, in order to access Hemodialysis was ready to use, it takes several weeks or even months. While he is not formed, you can use a catheter.

What are the complications of hemodialysis access setup?


These include thrombosing, narrowing the development of an aneurysm, infection and bleeding.

Caring for hemodialysis access:

  • daily check function is available
  • watch for any bleeding following dialysis. If the bleeding after dialysis takes longer than
  • expected, you should seek medical advice
  • do not lift weights with the hand, on which the Hemodialysis Access
  • do not sleep on your arm, on which the Hemodialysis Access
  • do not wear clothing or jewelry, compressing his hand, on which the Hemodialysis Access
  • not measure blood pressure on his arm, on which the Hemodialysis Access
  • watch for signs of infection and fistula stent
  • Keep clean in the field of hemodialysis access
  • Do not use any lotions or creams for hemodialysis access



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