Vascular Access Overview Dialysis, General Vascular Access Overview Vascular access is essential for hemodialysis. In order for all the blood to be properly cleaned during a treatment, blood needs to be rapidly transferred to and from the hemodialysis machine continuously. There are three types of vascular access. Arteriovenous Fistula Considered the “gold standard” of accesses, a fistula is created by using the patient’s own blood vessels; an artery is connected directly to a vein. The increased high-pressure blood flow makes the vein grow larger and stronger. This is the access of choice for all patients because it has fewest complications, such as infection and clotting; therefore, it lasts longer and there are fewer hospitalizations and deaths associated with it. However, not all patients have healthy enough blood vessels to successfully create a fistula. Tunneled Cuffed Catheter Catheters are flexible, hollow tubes that allow blood to flow in and out of the body. They are most commonly used as a temporary access to start dialysis or if the permanent access fails. Catheters should be avoided as much as possible because they are the leading cause of blood stream infection and have the highest rate of hospitalization and deaths in patients receiving dialysis. Arteriovenous Graft A graft connects an artery to a vein by using a synthetic or biologic tube. It does not need to develop as a fistula does, so it can be used sooner after placement. A graft is more likely to cause clotting or infection problems than a fistula but less than a catheter. Though it works well when new, it does not last as long as a fistula and needs more frequent repair to keep it working. Post navigation