Dialysis Access Management

Dialysis Access Management

For patients who depend on hemodialysis, maintaining a functioning vascular access is essential. Dialysis access — whether a fistula, graft, or catheter — requires ongoing monitoring and care to prevent complications and ensure reliable treatment. At Preferred Vascular Group, our board-certified vascular specialists provide comprehensive dialysis access management, from catheter placement through long-term access maintenance.

Catheter Placement, Care, and Removal

Many of the interventional procedures we provide rely on catheters — thin, sterile tubes inserted through small incisions using image guidance. For dialysis patients, catheters play a critical role in providing immediate access to the bloodstream.

Catheter Placement

A venous catheter provides temporary access for patients who need to begin hemodialysis immediately, before a permanent access (fistula or graft) has matured. The catheter is inserted into a large vein in the neck or chest, with the tip positioned near the heart. Extensions hang outside your chest or neck, allowing blood to flow to and from the dialysis machine.

What to expect during placement:

• The procedure is performed under local anesthesia with image guidance
• A small incision is made at the insertion site
• The catheter is carefully threaded into the vein and positioned using X-ray confirmation
• The incision is closed and the catheter is secured with sutures and a sterile dressing
• The catheter can be used for dialysis immediately

While catheters are not ideal for long-term use due to higher rates of infection and other complications, they provide a critical bridge while permanent access develops.

Catheter Flushing and Maintenance

Proper catheter care is essential to prevent complications:

• Regular flushing: Catheters must be rinsed with a heparin solution after every use to prevent blood clots from forming inside the catheter
• Sterile technique: The catheter exit site must be kept clean, dry, and covered with a sterile dressing
• Activity restrictions: Showering and swimming are not permitted while a catheter is in place to prevent infection
• Monitoring: Watch for signs of infection (fever, redness, drainage), catheter malfunction, or swelling

Your care team will provide detailed instructions for caring for your catheter at home between dialysis sessions.

Catheter Removal

Once permanent access (a fistula or graft) has matured and is functioning reliably, the temporary catheter is removed:

• The removal procedure is quick and performed under local anesthesia
• Pressure is applied to the exit site to prevent bleeding
• A dressing is applied and the site typically heals within a few days

Important: Never attempt to remove a catheter yourself or reinsert one that has come out prematurely. If your catheter is not functioning properly or becomes dislodged, contact your doctor immediately.

Permanent Access Options

When your temporary catheter is ready to be replaced, permanent access is created:

AV Fistula

The arteriovenous fistula is the gold standard for dialysis access [1]. Created by surgically connecting an artery to a vein, a fistula takes approximately 6-8 weeks to mature before it can be used for dialysis. Fistulas offer the best long-term outcomes, lowest infection rates, and fewest complications.

AV Graft

A graft uses a synthetic tube to connect an artery to a vein. Grafts are suitable for patients whose veins cannot support a fistula and can typically be used within 2-4 weeks of placement.

Access Surveillance and Problem Detection

Regular monitoring is essential for maintaining dialysis access function and catching problems early. Our comprehensive surveillance program includes:

What We Monitor

• Flow rates: Declining flow during dialysis sessions can indicate narrowing (stenosis) within the access
• Physical examination: Checking for changes in the thrill (buzzing vibration), bruit (sound), swelling, or signs of infection
• Needle placement issues: Difficulty with needle insertion may indicate access problems
• Elevated venous pressures: High pressures during dialysis can signal downstream narrowing
• Prolonged bleeding: Extended bleeding after needle removal may indicate elevated pressures

Warning Signs to Report

Contact your care team if you notice:

• Loss or weakening of the thrill in your fistula or graft
• Swelling, redness, warmth, or drainage at the access site
• Fever (may indicate access infection)
• Prolonged bleeding after dialysis
• Pain or tenderness at the access site
• Numbness, tingling, or coldness in the hand below the access
• Changes in the appearance of your access

Interventional Access Management

When access problems arise, our vascular specialists provide minimally invasive solutions to restore function quickly, often the same day:

Thrombectomy (Declotting)

When a fistula or graft becomes clotted (thrombosed), it cannot be used for dialysis. Our specialists perform catheter-based thrombectomy to remove the clot and restore access function:

• A catheter is guided to the clot using image guidance
• The clot is mechanically broken up and removed
• The underlying cause (usually stenosis) is identified and treated
• The access is restored, often allowing dialysis to resume the same day

Angioplasty

Narrowing (stenosis) within or near the access is the most common cause of access dysfunction. Balloon angioplasty opens the narrowed area:

• A balloon catheter is positioned at the narrowing
• The balloon is inflated to stretch the vessel open
• Blood flow is restored to normal levels
• May be combined with thrombectomy if clotting has occurred

Stent Placement

For areas of recurrent narrowing that do not respond adequately to angioplasty alone, a stent (small metal mesh tube) may be placed to hold the vessel open and prevent re-narrowing.

Access Revision

When endovascular techniques are insufficient, surgical revision of the access may be needed to extend its useful life. This may involve creating a new connection, relocating the access, or repairing a damaged area.

Collaborative Care Model

At Preferred Vascular Group, we work closely with nephrologists, dialysis centers, and primary care providers to deliver coordinated, proactive dialysis access care:

• Pre-dialysis planning: Working with nephrologists to create access well before dialysis is needed
• Ongoing communication: Sharing access status and intervention reports with your dialysis team
• Rapid response: Providing prompt evaluation and treatment when access problems arise
• Patient education: Helping patients understand how to monitor and protect their access

Why Choose Preferred Vascular Group?

Our vascular specialists have extensive experience in all aspects of dialysis access management. At Preferred Vascular Group, you receive:

• Comprehensive access care from initial catheter placement through long-term maintenance
• Rapid response to access emergencies, including same-day thrombectomy
• Minimally invasive interventions that restore function with minimal disruption to your dialysis schedule
• Proactive surveillance to detect and treat problems before they cause access failure
• Collaborative care that integrates seamlessly with your nephrology team
• Eight convenient locations across Georgia and Ohio

Your dialysis access is your lifeline. Our team is committed to keeping it functioning reliably so you can focus on your health and quality of life.

References

1. Lok CE, et al. “KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update.” American Journal of Kidney Diseases, 2020. PubMed
2. Defined et al. “KDOQI 2019 Vascular Access Guidelines: What Is New.” Clinical Journal of the American Society of Nephrology, 2022. PMC
3. Defined et al. “Duplex ultrasound evaluation for dialysis access selection and maintenance: a practical guide.” Seminars in Dialysis, 2008. PubMed