We know you have questions about dialysis access. That’s why our board certified vascular surgeons took the time to answer some of the most frequently asked questions we hear at our practice.
End Stage Renal Disease (ESRD) is the irreversible loss of kidney function. The two most common causes are hypertension (high blood pressure) and diabetes. The treatment for ESRD is either kidney transplantation, or dialysis and can be done through the bloodstream (hemodialysis). As vascular surgeons, we are asked by kidney doctors (nephrologists) to provide the means (access) by which dialysis can be accomplished.
Your nephrologist has determined that your kidneys are unable to remove wastes from your body. Dialysis is a way of removing the body’s wastes and toxins for patients with kidney failure. Dialysis occurs when a machine clears the blood of internal wastes. In order to clear your blood you will need to have a “dialysis access” to use a dialysis machine.
There are three basic methods of hemodialysis access: fistulas, grafts, and catheters. These are placed in your arms or legs by your vascular surgeon at Vascular Specialists of Central Florida to be used at your dialysis center for access so that you may undergo dialysis. You will need to undergo some sort of surgical procedure in order to create one of these accesses.
Do not let anyone draw blood or place IV’s in the veins of the arm to be used for dialysis access. This will ensure that the veins are not damaged prior to your procedure.
Your vascular surgeon at Vascular Specialists of Central Florida will create the access. This will be a surgery on your arm or leg. You may need a fistula, a graft or a catheter, or a combination of the two. Your vascular surgeon will also be the one who will maintain and repair the access if needed.
It may take a few days to a few months for the access to be ready for use. Only after your vascular surgeon gives the access center permission, should it be used. Until then, no one should use the access. Your vascular surgeon may order tests, such as ultrasounds, to make sure the access is working properly before it is used. Some patients will need to have additional surgery on the access to “fine tune” it before it can be used.
Your body will make blockages in the access, as it tries to close the access. You will need to have monitoring of the access to make sure it remains open and usable. If the access or if it clots off, you will not be able to use it for dialysis.
You will receive an ultrasound on your access every few months at our office to make sure the access is functional. The ultrasound allows us to see blood flow in the access and predict if a blockage is occurring.
Your vascular surgeon will monitor your access to make sure it is working properly. They may do this with an ultrasound or an angiogram, which is a specialized X-ray with contrast. Your vascular surgeon will determine when to perform these procedures. Usually, a test is performed every three to six months.
You should be able to feel a thrill in your access. If you or your surgeon determine that your access is not functioning properly, you may need a procedure at our office to clear the access of blockages. This is usually an outpatient procedure and is performed in our office. Some insurance will require this to be performed at the hospital. In the case of very large blockages, you may need to have your access repaired in surgery at the hospital.
Call our office immediately. Our office will schedule a time and a place to repair the access. It is important that you maintain contact with the physicians who performed the access in order to repair it.
In an emergency, any physician should be able to help you. Unfortunately, we can not guarantee the outcome of a procedure performed by someone else, even if you were sent by your dialysis center. We recommend that your surgeon determine who should perform procedures on your access. If you have any questions, call our office first.
Call our office at 407-648-4323 or 352-241-7585 and inform them that your access is not working. You will receive instructions. Dialysis Centers call 407-210-4242.