Dialysis for Kidney Failure

at SSM Health Saint Louis University Hospital

The Comprehensive Dialysis Access Center is a part of the SSM Health Transplant Center at Saint Louis University. We offer dialysis access services in one setting. Our surgeons are trained in the latest operative and interventional techniques, treating chronic kidney disease patients in a manner that preserves their dialysis access options into the future.

More importantly, we work to ensure long-term maintenance of your dialysis access. You will be able to have your dialysis access needs met while being simultaneously evaluated for kidney transplantation at one of the leading kidney transplant programs in the country.

We know this process can be scary and confusing, but we’re here to help. Contact us today to learn more about how our services can improve your quality of life. To make an appointment, call us today at (314) 577-8867.

Our Comprehensive Dialysis Access Services

To best serve your needs, our team offers a comprehensive range of services to create and maintain dialysis access, including:

Comprehensive initial evaluation to determine the best type of access for each patient
Creation of AV Fistulas
Creation of AV Grafts
Insertion of peritoneal dialysis catheters
Insertion of venous catheters
Diagnosis and management of dialysis access complications such as clotting and infection
Diagnosis and management of peritoneal dialysis catheter complications

Hemodialysis Access Options

Before starting hemodialysis sessions, it’s important to prepare a dialysis access – the site on your body where blood is removed and returned during dialysis. For optimal hemodialysis, the dialysis access should allow the blood to flow continuously at high volumes. Therefore, your dialysis access should be prepared long before starting dialysis, allowing for easier and more efficient removal and replacement of your blood with fewer complications.

There are three basic types of dialysis access for hemodialysis, including:

Arteriovenous (AV) Fistula - A fistula is a connection made between blood vessels (an artery and vein) that causes the vein to grow larger and stronger, and is therefore a good site to use for accessing your bloodstream during dialysis. Because the vein needs to grow and become stronger, fistulas generally take two to three months before they can be used for dialysis. Fistulas are the preferred type of dialysis access, because fistulas last longer and are less likely to have complications such as blood clots and infections.
Arteriovenous (AV) Graft - An AV graft is a synthetic material used to connect the artery and vein that serves as an artificial vein that can then be used as your hemodialysis access site. AV grafts are used less commonly than fistulas; however grafts are necessary for some patients who have small veins.
Venous Catheter - A venous catheter is a tube placed into a vein in the neck, upper chest, or more rarely, the upper leg near the groin. A catheter is considered temporary dialysis access, because it carries a higher risk for clots, infections, and may cause damage to your veins if used for a long period of time.

Interventional Nephrology Program

SSM Health Saint Louis University Hospital nephrologists performed their first interventional nephrology procedure in March 2000. Since then, the service has grown into a comprehensive, nationally recognized, interventional nephrology program. In 2010, our team of interventional nephrologists performed more than 1,200 procedures – approximately 100 per month. The Interventional Nephrology Program includes the following procedures:

Angiography and angioplasty of AV fistulae and grafts
Angiography and angioplasty of the central venous system
Placement, maintenance and removal of tunneled dialysis catheters
Placement of PICC lines and ports
Thrombectomy of AV fistulae and grafts
Placement of intravascular stents
Coiling of accessory veins in the management of poorly developing AV fistulae
Placement of trans-lumbar dialysis catheters
Trans-jugular renal biopsy
Percutaneous biopsy of native and transplanted kidneys
Placement of abdominal and pre-sternal peritoneal dialysis catheters

What to Expect from Dialysis Access Surgery

It can be scary to have any procedure done, but it helps to prepare yourself as much as possible beforehand. Your operation will usually be scheduled at a time that is best for you, except in urgent cases. As the date of your surgery approaches, be sure to notify our office about any changes in your health. For instance, if you have a cold or the flu, this may lead to infections, which could affect your recovery. We’ll also need to know about any medications you are taking, including over-the-counter medicines such as aspirin. We will also provide you with a complete set of instructions about the procedure.

Before Your Stay

You could be admitted to the hospital the day of your surgery or the morning of surgery. Because anesthesia – the medicine that makes you sleep during surgery – is safer on an empty stomach, you will be asked not to eat or drink anything after midnight the night before. If you do eat or drink something, it is crucial to tell your anesthesiologist and surgeon. Smoking can lead to problems with blood clotting and breathing, so if you are a smoker, you should stop at least two weeks prior to surgery.

Day of Your Surgery

On the day of your surgery, your doctors may perform an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest x-ray in order to get a picture of the latest information about your health. In the operating room, you will be in good hands with one of our world-class surgeons, who will lead the surgical team. The surgical team will consist of surgical nurses and an anesthesiologist.

The surgeon will then create the AV fistula or AV graft in one of your arms. If you are right-handed, the fistula or graft will usually be placed in your left arm. If you are left-handed, the fistula or graft will usually be placed in your right arm. The procedure takes approximately one to two hours to complete.

Recovery

After your surgery, you can use your arm as normal as long as you avoid heavy lifting. If you had a catheter placed so you can have hemodialysis while your AV fistula or graft is healing, you cannot get the catheter wet.

The AV fistula procedure is an outpatient procedure, meaning you will not need to stay overnight in the hospital. An AV fistula can get wet 24 to 48 hours after your procedure.

If you receive an AV graft, you will likely need to spend the night in the hospital for observation. Sometimes there is swelling or redness in the area where the graft is placed. The swelling will usually go away if you prop your arm on one or two pillows, and keep your elbow straight and relaxed. Call your doctor if there are signs of severe redness or swelling, or if your arm suddenly becomes numb or weak.

Life After Your Dialysis Access Surgery

You should avoid heavy lifting. Any injury to your arm can cause bleeding. When you go to the doctor, do not let anyone take your blood pressure, start an IV, or take blood from your arm with the AV fistula or graft.

If you have an AV graft, you should avoid wearing anything tight around your wrists or arms. Clothing or jewelry that is tight can decrease the blood flow in the graft, which can lead to blood clots within the graft. Also, do not lie or sleep on top of your arm.

You should always be able to feel blood rushing through your AV graft. This feeling is called a “thrill.” You will also notice a slight vibration in the graft when you put your fingers on the skin over the graft.

Being Prepared for Your Dialysis Access Procedure

Your SLU Hospital healthcare team will help you prepare for your dialysis access procedure, including what to expect and how to care for your access site. Don’t hesitate to call us at (314) 577-8867 to discuss your questions or concerns.