Vascular Access Failure

Overview

Any type of dialysis access has some risk of failure. So it's important to always protect your access and be alert for signs of clotting or infection.

• Call your doctor right away about any signs of trouble.
• Make a habit of talking with your dialysis nurses and doctor about how well your access is doing.

If your dialysis access fails, it will be repaired or replaced. You and your doctor will choose your next best option for dialysis access. To keep up a regular dialysis schedule, you need a sturdy dialysis access where blood can flow in and out of the body.

What are the options for hemodialysis access?

There are a few ways to access the veins for hemodialysis.

Permanent access

There are two permanent access types:

• An arteriovenous (AV) graft is made by inserting a small tube between an artery and a vein. It's usually in the upper arm or forearm. A graft is a good choice if you have small veins or other problems. It can sometimes be used as soon as 1 week after placement. But a graft may not last as long as a fistula. It's more likely to get infected or to get narrow and cause blood clots.
• An arteriovenous (AV) fistula is made by directly connecting an artery to a vein. It's usually in the upper arm or forearm. A fistula tends to last longer than a graft, and it's less likely to cause blood clots and get infected. You have to plan ahead for a fistula. That's because it needs at least several months to heal after placement. But a fistula is the most dependable access type.

Short-term dialysis access

If you need to start dialysis right away, your doctor may place a tube in a vein. It's usually in your neck or chest. This is called a central vascular access device. You can use it while your permanent access heals.

How do you help prevent access failure?

Every day, check your access to be sure it's in good condition. Pay attention to how you feel.

Call your doctor or dialysis team right away if you have any signs of infection or a blood clot, swelling, or unusual skin colour.

• Be alert for signs of infection.

  These signs include:

  • Increased pain.
  • Swelling, redness, or red streaks.
  • Blood or pus draining from the access.
  • Numbness.
  • Fever.
• Check your access for a pulse, or "thrill."

  A thrill is a vibration. It's a good sign that you don't have a blood clot. To feel it, place your first two fingers over the access, or listen with a stethoscope. You should be able to hear a regular whooshing sound. This is called a bruit (say "BROO-ee").

• Check for signs of good circulation.

  It's a problem if your hand or arm is cool or pale or changes colour, or if you have sudden bulging around your access.

After you have dialysis, call your dialysis team right away if bleeding from your access lasts longer than usual.

How do you protect your access?

It's important to take care of your vascular access so that it works well. Any access has some risk of failure. So follow these tips to protect your access.

• Do not lift anything heavy with your access arm.
• Do not bump your access arm.
• Don't wear tight clothing or jewellery over that arm.
• Don't sleep with your access arm under your body.
• Do not have blood drawn or blood pressure measured on your access arm.
• Don't put cream or lotion on or near the access.
• Keep the area clean and dry.
• Tell your health care team right away if you notice anything unusual in how your access looks or feels.

How is vascular access failure treated?

When a vascular access fails, your doctor needs to quickly repair or replace it. It has to work well so you can keep up with your dialysis sessions.

• If blood flow is blocked, your doctor may be able to clear it with a tiny balloon or tube (stent). Sometimes a blood clot can be cleared with blood thinner medicine.
• If your access is infected, you will get antibiotic medicine.
• If your access needs time to heal, you will have a tunnelled catheter for dialysis. You'll have this for a few weeks until your permanent access works again.
• If you need a new permanent access, talk to your doctor about your options.