Week of July 11, 2006
Choosing and Caring for Your Vascular Access
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 Welcome to KidneyTalk!
On this week's show, Lori Hartwell, Stephen Furst, and their guests talk about
the all-important vascular access. The access is how your dialysis staff (or
you, if you practice self-care) gain entrance to your bloodstream to perform
hemodialysis. The access is so important to hemodialysis patients that it's
often called their "lifeline."
There are different types of vascular access, and they're not all the same.
Often, it's up to you to decide which type of access you will end up with.
Education is key when you have to make tough decisions, so this week we're
discussing the importance of choosing the right vascular access in order to
receive optimal dialysis, as well as how to care for it.
There are three types of vascular access for hemodialysis: fistulas, grafts, and
catheters. The most critical piece of information a kidney patient needs to know
before starting dialysis is which type of access is best.
 Most healthcare professionals agree that the first and best choice is a fistula.
A fistula is created when a surgeon connects one of your arteries to one of your
veins, usually in your arm. Some dialysis patients have had their fistulas for
more than 30 years! Nephrology nurses are among the first to point out the
superior benefits of fistulas--which, unfortunately, are not recommended for
everyone. "Not all patients are able to have a fistula due to other medical
conditions or because their vessels aren't healthy enough," says Vickie Peters,
RN, Special Projects Coordinator for ESRD Network 18. "However, if you can have
a fistula, it's definitely the best."
Lana Kacherova, RN, Quality Improvement Director for ESRD Network 18 (which
covers the Southern California region) agrees: "Not every single patient will be
a good candidate for a fistula, but every single patient has to advocate for
themselves to see if they are a candidate."
Another type of vascular access is a graft. It is a flexible plastic tube that
surgeons use to connect one of your arteries to one of your veins--again,
usually in your arm. The problem is that a graft might last only 3 to 4 years
and then needs to be replaced. Lori knows all about this: She once missed a
concert because she was in surgery getting her graft replaced. (Ouch twice!)
Largely because of the increased possibility of infection, the least desirable
type of access is a permanent catheter. Similar to a graft, a catheter is a
plastic tube; however, it is placed ("tunneled") under the skin and does not
connect an artery to a vein. Rather, one end of the catheter remains outside the
body, usually in the chest, and the other end goes directly into a vein.
Although some patients receive hemodialysis through a catheter for quite some
time, it ordinarily is not meant to be used long-term. Says Lana, "They really
should call this a 'temporary' permanent catheter. This is not a good option, as
there is a great chance of infection with catheters. We prefer fistulas."
Because of the longevity of fistulas, as well as associated techniques that can
reduce the amount of discomfort when needles are inserted, they are definitely
the access of choice for today's kidney patients. Vickie advises patients to be
aware (and to remind their healthcare professionals to be aware) that they need
to try to preserve their blood vessels when they undergo medical procedures such
as surgery or having an IV placed. The reason is that you need to keep enough
good blood vessels available for placement of a graft--or better yet, a
fistula--down the road.
"Advocate for a fistula with your physician," encourages Vickie, who also
suggests checking with your dialysis staff about related techniques (such as the
"buttonhole" method or same-site sticking) that will make hemodialysis less of a
burden and more of what it was designed to be: a wonderful technology allowing
you, along with a few hundred thousand others, to live the full life you were
meant to.
For more information on fistulas, please visit the following websites:
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