Vascular Access
Fistula creation, catheter insertion and access surveillance, because dialysis is only as good as the access it runs through.
Access is the part of dialysis that patients think least about and that determines the most. A well functioning fistula gives efficient dialysis for years with a low infection risk. A catheter left in place too long is one of the commonest routes to a life threatening bloodstream infection.
The options
- Arteriovenous fistula, created by joining an artery to a vein, usually in the forearm or upper arm. Best long term option, lowest infection risk, needs six to twelve weeks to mature
- Arteriovenous graft, using a synthetic tube where veins are unsuitable. Usable sooner than a fistula but with a higher rate of clotting and infection
- Tunnelled catheter, placed in a large central vein. Usable immediately, appropriate as a bridge, carries the highest infection risk
- Temporary catheter, for emergency dialysis only and removed as soon as alternative access is available
Looking after a fistula
Check it every day. You should be able to feel a continuous buzzing, called the thrill, and hear a whooshing sound if you listen. If the thrill stops or weakens, contact the unit the same day, because a clotting fistula can sometimes be salvaged if caught early and cannot be if it is not.
- No blood pressure cuffs on that arm
- No blood samples or drips in that arm
- Do not sleep on the arm or wear tight sleeves, watches or bracelets on it
- Do not carry heavy loads with that arm
- Keep the skin clean and report any redness, swelling, pain or discharge immediately
Common questions
When should a fistula be created?
Well before dialysis is expected to start, ideally when kidney function has declined to the point where dialysis is anticipated within six to twelve months. Creating it early avoids starting dialysis through a catheter.
Does fistula surgery require general anaesthesia?
Usually not. It is typically performed under local or regional anaesthesia as a day case.
Who looks after your relative
Care in the unit is led by our consultant intensivist, with critical care nurses at the bedside continuously and specialist input from nephrology and anaesthesia where the case calls for it.
Dr Rita IrurheChief Executive Officer, SkyHigh Medical CentreMeet the team →What this costs
Cost depends on the level of support actually needed, so we quote rather than publish a rate card. Call the unit and you will be given the current figure, what would change it, and where your HMO cover stands, before treatment wherever the situation allows.
Costs and coverNext step
If you need a bed tonight, call. We will tell you straight away.
The unit is staffed at every hour. Referring clinicians should call before transferring a patient so availability can be confirmed and the team can be ready on arrival.