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ACCESS CREATION FOR DIALYSIS

Before a patient receives dialysis treatment for ill-functioning kidneys, they must undergo a preoperative procedure for the creation of an access point to filter out blood using a dialysis machine (dialyser). The dialyser contains fine fibres that are used to drain waste and a surplus of fluid from the body. In return, the machine delivers clean blood to the body via a secondary tube. Usually, the arm or wrist serves as an access point, allowing Dr Manyangadze to attach the artery to the vein. Haemodialysis is a life-saving procedure that prolongs a patient’s life and makes their lifestyle easier. 

Haemodialysis is created for patients with kidney failure. Kidney failure means that the kidneys, one or both, can no longer function optimally. The patient’s risk of renal failure increases if they have been diagnosed with underlying conditions such as diabetes

 
 

As a result, the patient experiences the following symptoms:

  • Tiredness
  • Vomiting
  • Swelling in the ankles and hands
  • Frequent urination
  • Dry, irritated skin
  • Lack of appetite

THE PROCEDURE

Vascular access ensures a large supply of blood is filtered through the body. Approximately a pint of blood should flow through the dialyser per minute. Dr Manyangadze schedules vascular access a week or month in advance of the full procedure.

Two forms of lifelong vascular access exist an arteriovenous fistula and an AV graft. Alternatively, a venous catheter is used over a short time. An AV fistula is a connection created between the artery and vein. Dr Manyangadze places an AV fistula in the arm or forearm, depending on what suits the patient. The AV fistula increases blood flow to the vein, increasing the strength of the vein. A larger vein makes it easier to reach blood vessels. This type of connection ensures future haemodialysis treatments are possible.

An arteriovenous (AV) graft is a plastic tube in the form of a loop that attaches the artery to the vein. A local anaesthetic is used to numb sensation in the area to prepare the graft. An AV graft can be used at least two weeks after the surgery and, if well cared for, can last a few years.

A venous catheter, or permanent catheter, is a tube that can be placed in the vein in the groin, leg, chest or neck. The tube divides into two, where the ends attach to the dialyser. The caps attached to the two halves of the catheter help the tube carry blood to and from the dialyser. It is usually used as a bridge to AVF/AVG or on a temporary basis.

Access creation for dialysis

Peripheral arterial disease

Aneurysms

Venous disorders. mainly varicose veins and DVTs

Strokes

 

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FAQ

1Why does Dr Manyangadze recommend AV fistula over other means of surgical access in preparation for dialysis?

An AV fistula carries the following benefits:

  • •Improves blood flow which is conducive to dialysis
  • AV fistula lasts longer than any other means of access
  • Boasts a minimal risk of infection or blood clots
2What is a vessel mapping test?
A vessel mapping test is used to identify the veins that will be used to create the AV fistula. The test relies on a Doppler ultrasound to create images of the blood vessels.
3How long does it take for the AV fistula to develop?
It usually takes 6-8 weeks for the fistula to develop. Should the AV fistula fail to mature, Dr Manyangadze will have to perform a second procedure, such as endovascular ballooning of the fistula segments, to assist with the maturation of the AVF.