Dialysis access

A dialysis access is a site on a person's body created so that blood or other fluids can be removed, filtered, and returned to the body during dialysis. Dialysis is a process that performs the work of healthy kidneys for people who have kidney failure.

Before dialysis can begin, the doctor has to create a dialysis access. For hemodialysis, the access is the place where the dialysis needles are inserted to send the blood to and from the dialysis machine. In peritoneal dialysis, the access is the place where a catheter is connected so fluid can flow into and out of the belly.

Depending on the type of dialysis, the doctor may:

• Attach an artery to a vein, usually in the lower arm. This is called a fistula. Once the fistula is healed, the dialysis needles can be put directly into it. Fistulas tend to be stronger and less prone to infection than grafts.
• Implant a tube (graft) under the skin of an arm or leg that connects an artery and a vein. The dialysis needles can then be put into the graft for hemodialysis. A graft is a good choice if the person has small veins or other problems.
• Place a tube (catheter) in the belly for peritoneal dialysis.

Usually, the doctor has to prepare the dialysis access weeks to months before it is needed. This allows the access time to heal. If a person needs emergency dialysis, the doctor may create a temporary access by inserting a catheter into a vein in the neck, upper chest, or groin.