A nurse is caring for a client who has a new arteriovenous graft in his left forearm

Your kidneys are two bean-shaped organs that lie just below your rib cage, on each side of your spine. The kidneys do many good things for the body. Their main job is to filter the body's blood supply to remove extra water, salt and the waste products left over after the body uses the energy it needs to live. The extra fluid and waste leave the body when you urinate.

Since the body is made up mostly of water, the kidneys make sure there is the right balance of fluid for the body to stay healthy. The kidneys also control blood pressure, maintain the levels of certain chemicals in the blood and make hormones necessary for the body to function correctly.

When the kidneys do not work, the blood must be filtered another way. This is done using a treatment called dialysis. Dialysis does what the kidneys are no longer able to do, through a series of filters and semi-permeable membranes. Hemodialysis, specifically, is the process of filtering blood. Hemodialysis requires vascular access through a blood vessel (vein or artery). These access sites are obtained via non-invasive methods (no incisions required / small puncture / low to moderate sedation) stated below.

Types of Hemodialysis Access

• Arteriovenous (AV) fistula: An AV fistula is the connection of an artery to a vein, usually in the forearm. This connection causes extra blood to flow through the vein, which makes it grow larger and stronger. This allows for repeated use during dialysis. AV fistulas are considered the most ideal type of vascular access because they provide good blood flow, last the longest, and are the least likely to become infected or cause clots
• Arteriovenous (AV) graft: An AV graft is similar to that of an AV fistula, but instead of connecting the patient’s artery to a vein, a teflon tube (hollow, synthetic tube) is used for connection. An AV graft may be used if the patient’s blood vessels are too small or clotted to create an AV fistula. AV grafts mature quicker than fistulas but clot and get infected easier, thus, used far less

How to prepare for the procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure, and potential risks of the procedure. Other recommendations include:

Talk to your doctor about

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents
• Any history of bleeding disorders

Other suggestions

• Leave all jewelry at home
• Remove all makeup and nail polish
• Wear comfortable clothing when you come to the hospital
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect before the procedure

To determine whether you need dialysis, your doctor might perform a variety of tests, including:

Diagnostic tests and procedures

• Ultrasound
• Angiogram
• X-rays

What to expect during the procedure

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Dialysis access creation usually takes 1 hour. Creation of these access sites can take place in a hospital or outpatient setting (e.g. doctor’s office). Check with your doctor about the details of your procedure. In general:

During an AV fistula procedure

• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure
• Local anesthesia will be administered to the chosen insertion site (typically the forearm of your non-dominant arm)
• After the local anesthetic has taken effect, your doctor will make a small incision around the insertion area. This will allow access to the selected artery and vein
• Your doctor will divide the vein and sew it to the side of an artery when an opening has been made
• Once the access creation is complete, the procedure is finished. The AV fistula will typically take 3 to 6 months to mature and be ready for use

During an AV graft procedure

• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure
• Local anesthesia will be administered to the chosen insertion site (forearm, upper arm or groin)
• After the local anesthetic has taken effect, your doctor will make a small incision around the insertion area. This will allow access to the selected artery and vein
• Your doctor will sew the graft to a vein and the other end of the graft is connected to an artery
• Once the access creation is complete, the procedure is finished. The AV graft will typically take 2 to 6 weeks to be ready for use

What to expect after the procedure

Individuals who had an AV fistula procedure will most likely go home the same day. Those who had an AV graft however, will stay in the hospital for at least one night. Other recommendations include:

General guidelines

• A nurse will monitor your vital signs, the insertion site, circulation and sensation in the affected leg or arm
• It is important to keep the access site(s) raised above the level of your heart to reduce both swelling and pain
• Your doctor may recommend pain medication if needed
• Initially, you may feel numbness of the hand, but these symptoms should subside in a few weeks as your circulation regulates
• Your doctor will give you instructions to follow during your recovery