A dialysis access is a portal beneath your skin that allows access to your bloodstream. It typically is in the arm but also can be in the leg. The access allows blood to be removed and returned to your body efficiently and safely and is used most commonly during dialysis.

A dialysis access provides an entry and exit for the blood during dialysis, the most common treatment for kidney failure. When the kidneys fail, they are no longer able to clean and filter the blood as it circulates through the body. During dialysis, a portion of blood is removed through the dialysis access and circulated through a dialysis machine, which removes wastes, extra salt and extra water. The cleaned and filtered blood is then returned to the body through the dialysis access.

Access portals most commonly are placed completely under the skin, which requires a minor surgical procedure. The two common types of access are:

Fistula: A connection made when a surgeon joins an artery directly to a vein. This type of access can take several weeks to develop before it is ready for use, but it is the preferred method. Because fistulas use your own blood vessels, they are typically more durable and less prone to infection.
Graft: A connection made when a surgeon inserts a man-made tube under the skin that connects an artery to a vein. A surgeon may choose this method if veins are too small to use or are blocked. Unlike a fistula, a graft does not require time to develop, so it is ready for use sooner. However, there is a greater risk for infection and clotting.

Kidney dialysis is usually done three times per week and requires regular and long-term access to the bloodstream. Dialysis access provides easier, more effective access to the bloodstream. Creating an access by connecting an artery to a vein with a graft or a fistula also allows more blood to flow through the vein, stretching and strengthening the vein. Increased blood flow makes dialysis more efficient by allowing more blood to be cleansed during the procedure with fewer complications.

Why choose Ohio State for dialysis access treatment?

Since we are an academic medical center, our patients benefit from innovative research, a depth of medical expertise and the newest technologies and treatment techniques available.

What to expect during dialysis access

Preparing for your procedure

A dialysis access should be prepared weeks or months before dialysis begins. A fistula usually takes about six weeks to develop. As more blood flows through the connection and the fistula matures, the vein becomes stronger and enlarges. It may look as though a cord is running under the skin.

A graft connects an artery and a vein with a man-made tube and does not require time to develop. It can be used as soon as it has healed, usually within two to three weeks.

Before the procedure, your surgeon will need to determine the best location for the access. The site needs to be located in an area of the body that has sufficient blood flow. Your surgeon may order an ultrasound to test the blood flow in your arms and legs. Most often an access is placed in the forearm because atherosclerosis (a condition that reduces blood flow) more commonly occurs in the legs.

During your procedure

Dialysis access typically is done as an outpatient procedure. You will be sedated and the surgeon will numb the area where the fistula or graft is being placed.

The surgeon will construct the fistula by connecting a vein directly to an opening in the side of a nearby artery. If you have small veins, your surgeon will connect the artery and vein using a synthetic graft or, less commonly, a piece of vein from your leg.

After your procedure

Some pain and swelling at the access site is normal after surgery. Keeping the access area raised above the heart should help reduce the swelling. Your physician may recommend an over-the-counter pain reliever if needed.

After the surgery, the following recommendations will help the access heal and keep it working properly:

Keep the incision dry for at least two days and do not soak or scrub the incision until it has healed
Avoid activities that can stress or compress the access, such as digging, and do not lift more than 15 pounds
Tell your physician immediately if you have bleeding, drainage, pain, swelling or a fever over 101 degrees

A fistula will typically last three to seven years and a graft one to two years. However, you can extend their use with proper care and protection: