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How is the blood taken out of the body for dialysis?
The process is enabled by gaining access into the blood circulation either by catheters, or by constructing a fistula or a graft. This is called as obtaining vascular access.
Where are the catheters usually inserted?
The catheters are usually inserted in the internal jugular vein in the neck or in the subclavian vein (located below the collar bone).
How long can the catheters be used?
Usually they can be used for a few weeks (max. 4 weeks) which gives some time to construct a more permanent access. The silicone catheters (Permacath) can be used for much longer periods, from 6–12 months.
Does the catheter require any general anesthesia?
The insertion of the catheter does not require any general anesthesia.
Are there any complications associated with the procedure?
Bleeding, injury to the lung or nerves can occur. These complications in experienced hands are rare. The catheters can get infected in which case they must be removed.
What is a fistula?
The fistula is an anastomosis (joining) of an artery to a vein, which makes the vein bigger and thicker so that it can be used to insert needles for dialysis. The fistula is usually created in the non dominant arm to facilitate self dialysis and limit the consequence of any functional disability if it should occur.
How long can a fistula be used?
As long as it works. The AV fistula is the safest and longest lasting permanent access.
When should a fistula be placed?
The AV fistula ideally should be placed 2 to 6 months prior to initiation of hemodialysis. It is extremely important during the evaluation of the patient of chronic renal failure to preserve the arm which means that no needles should be placed into the vein at any time for drawing blood or giving medications.
Once the fistula is created how soon can it be used?
The fistula once it has been constructed should be given time to mature. The time period usually varies from 4 to 8 weeks. 4 weeks being usually the minimum time required. The perforation is with needles of either 15 or 16 gauge.
Are there any complications of fistula?
- Bleeding from fistula.
- Infection of the fistula is rare.
- Clotting of fistula is rare. More common in diabetics.
- Swelling of the hand.