Types of Access for Hemodialysis

TYPE 1: FISTULA

A fistula is a natural type of vascular access where your own vein is surgically connected to an artery. The increased blood flow that results from this connection causes the vein to become larger and stronger.

The fistula is the preferred access for hemodialysis because of its low complication rate and longer life-span as compared to other vascular access options available.

TYPE 2: GRAFT

A graft is a length of artificial tubing surgically connected to your blood vessels: one end to an artery and the other to a vein. Just like the fistula, it too resides completely under the skin.

The graft is the second choice for vascular access because it does not usually last as long as a fistula. 

In order to work properly for dialysis, both a fistula and a graft must have higher blood flow rates going through them than normal or "native" veins. Hemodialysis is performed by inserting two needles into the access and connecting the lines to the dialysis machine.

TYPE 3: CATHETER

A catheter (also known as a Central Venous Catheter or CVC) is a tube-like device that is inserted into a large vein, usually in the neck or groin. The visible exterior portion has two small tubes with caps. The remainder of the catheter (the part you do not see) travels under the skin and into a vein. Ultimately, the internal end of the catheter rests in the top chamber of your heart.

Because so much of the catheter resides outside of the body, it is exposed to many more risks, including infection. It can potentially lead to complications and is therefore intended to serve only as a short-term vascular access until either a fistular or graft can be placed.

The higher complication rates associated with catheter use makes it the least desirable type of access. Catheters are intended for temporary use until a permanent access can be placed.