What is Dialysis Vascular Access?

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Dialysis patients need an access to their bloodstream for dialysis.

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This access allows the blood to be filtered; dialysis 3 times a week for about 4 hours.

 

Without access, the patient cannot receive dialysis and is at risk for death.

 

There are several types of vascular access for dialysis. 

 

Fistulas: The Gold Standard

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The majority of Medicare beneficiaries with ESRD receive dialysis treatments to sustain life. Before patients with ESRD can initiate dialysis treatment, access to their bloodstream is required.

To access the patient’s bloodstream, options are:

 

• Surgical creation of a fistula, which is a connection between an artery and a vein;

• Central vein catheter, which is an external tube placed through the skin and advanced to veins in the chest; and

• Graft, which connects an artery to a vein with an implanted synthetic tube.

 

Selecting and maintaining an appropriate vascular access is essential to safe hemodialysis. Fistulas are recognized as the best vascular access option for most patients.

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AV fistulas have the lowest infection rates, better patency, fewer interventions and less hospitalizations while central venous catheters have the highest infection rates, lower patency and increased hospitalizations according to CDC national surveillance data.  Reducing avoidable catheter dependence is therefore an important  priority. Fistulas also have the lowest annual total cost of care when compared with catheters and grafts.

Access selection should follow an individualized ESKD Life-Plan that considers the patient’s anatomy, likelihood of successful access use, anticipated dialysis duration, and patient preferences.