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The Dialysis Access Operation

Hemodialysis

Hemodialysis cannot begin until doctors establish a vascular connection between your bloodstream and the dialysis machine. Surgeons create vascular access in the arm or leg for hemodialysis by surgically placing a shunt, called arteriovenous (AV) fistulae, as well as grafts that connect arteries to veins. Sometimes it is necessary for surgeons to place a catheter in the chest if hemodialysis is needed urgently, or if arm or leg access is not ready to use at the time hemodialysis is needed.

The surgery is performed in the operating room. You will receive a local anesthetic (numbing medicine) at the proposed access site, as well as some sedation. Some patients fall asleep during the procedure, while others feel some minimal discomfort.

To create a fistula, surgeons make a small incision in either the wrist area or at the crack of the elbow. During the surgery, a vein is sewn to the artery. This creates increased flow and pressure in the vein which hopefully will make it enlarge over time. This large vein will eventually be used for your dialysis. You will have a small incision covered with a dressing after the surgery. You will either have dissolvable stitches under the skin or external stitches that will be removed in 2-3 weeks time.

To create an arteriovenous (AV) graft, surgeons make a small incision at the proposed access site. The graft is sewn to an artery and tunneled just under the skin, creating a loop back to the starting incision, where it is then sewn to a vein. The long loop gives your dialysis access nurse space to access the graft. Your graft incision will also have external stitches covered by a dressing. The stitches will come out in your post-op visit.

The operation takes 1-2 hours with another 1-3 hours for recovery. Once your dialysis access team feels you are well enough, you will be able to return home.

Peritoneal Dialysis

Peritoneal dialysis cannot be started until the special peritoneal dialysis catheter is surgically placed in the abdomen. The catheter is a long silicone-based tube that carries the special dialysis fluid into the abdomen to flush out toxins.

The surgery is performed in an operating room. You will receive a local anesthetic (numbing medicine) at the proposed access site, as well as some sedation. Some patients fall asleep during the procedure, while others feel some minimal discomfort.

To position the catheter, the surgeon makes a small incision in your abdomen, advances the tube deep into the lower part of your peritoneal cavity, tunnels the tube under the skin for several inches, and brings the tube up through the skin at a different location. The surgeon then surgically closes the incision and covers the part of the catheter remaining outside the body with a sterile dressing.

The operation takes 1-2 hours with another 1-3 hours for recovery. Once your dialysis access team feels you are well enough, you will be able to return home.

Contact Information

Transplant Institute
Beth Israel Deaconess Medical Center
Lowry Medical Office Building, 7th Floor
110 Francis Street
Boston, MA 02215
617-632-9700