Preparing for a Dialysis Access
The first step in getting ready for dialysis
How We Set You Up for Successful Treatment
There are two treatments for kidney failure: kidney transplant and dialysis. If you don’t have a kidney transplant, kidney dialysis is vital to maintaining your quality of life.
Factors such as your specific medical condition and your lifestyle help determine which of the two forms of dialysis — hemodialysis and peritoneal dialysis — is likely to be best for you. Each type has pros and cons. Our team educates you about both, so you can make an informed decision. But no matter which type of dialysis you choose for yourself, the first step is having dialysis access surgery.
When Should I Get Dialysis Access Surgery?
It’s usually best to undergo access surgery well before dialysis becomes necessary. Placement of a temporary dialysis catheter allows for treatment right away. But there’s healing time involved with permanent catheters that make long-term access possible. Having access surgery early may help you avoid the need to have a temporary catheter and two procedures.
More About Preparing for Dialysis Access
Once you and your team have decided what kind of dialysis access you need, you meet with your dialysis access nurse coordinator. They schedule your operation and provide information about having surgery at Beth Israel Deaconess Medical Center (BIDMC). They also help set up tests and appointments you must have prior to surgery. These may include:
- A meeting with an anesthesiologist
- An electrocardiogram (EKG)
- Blood tests
- Chest X-ray
Depending on the type of dialysis you have, you may get other instructions to help you get ready, as well.
If you have a high body mass index (BMI) and are interested in losing weight, the Dialysis Access Center offers a weight loss program. Weight loss is beneficial to prevent complications before, during and after your surgery. Our nutritionist will provide you with weight-loss tools and resources, such as meal plans, recipes and educational materials. We encourage follow-up appointments every four to six weeks with the nutritionist to check on your progress. You may also benefit from discussions with our Behavioral Health specialists. They can help you address issues linked to overeating, such as depression and stress. They can also help you set strategies and goals.
Before dialysis access surgery, you undergo an evaluation. It involves meeting with a dialysis access nurse coordinator and a transplant surgeon. Both have extensive experience with dialysis access. They'll be able to answer any of your questions. Nephrologists (kidney specialists) and interventional radiologists are also part your dialysis access team.
The team will conduct a physical exam and review your medical history. They’ll also ask you about any experience you may have had with dialysis access. It’s important to let us know if you’ve had any surgery or procedures that involved putting lines in your neck. It’s also important to tell us if you have a pacemaker. This information could potentially impact how your surgeons create access for your dialysis treatment.
During your evaluation, you undergo medical tests including:
- Noninvasive vein mapping with an ultrasound or other tests to study your blood vessels. This helps surgeons determine which veins they can use for your hemodialysis access.
- Blood tests.
With all your test results, we can determine the type of access that would work best for you and the best access site.
Testing takes place on an outpatient basis. We perform many of the tests at the Transplant Institute in Boston. But it’s possible to do some of the tests at a hospital or clinic closer to your home.
When you have kidney failure, dialysis may be lifesaving. But the treatment isn’t possible without access surgery. Improved quantity and quality of life are the benefits of access placement. As with any type of surgery, however, the benefits come with some risks:
- Infection: Infection is one of the biggest risks. This risk is lower with permanent catheters than with temporary ones. That’s because we tunnel permanent catheters under your skin for several inches before introducing them to your venous system. Surgeons or interventional radiologists must place permanent catheters with the guidance of fluoroscopy. But any medical professional can place a temporary catheter. Even with excellent placement, bacteria can enter your bloodstream through your catheter. Bacteria from your skin can also move down the catheter and enter the bloodstream. If an infection develops, we usually remove your catheter. This helps your body fight the infection. Permanent catheters require a minor procedure for removal. We can simply pull a temporary catheter out.
- Blood vessel damage: Damage to your main chest vessels can occur with long-term catheter use. This can lead to stenosis (narrowing) or thrombosis (clotting) of the veins. The damage is usually permanent. And the vessel — as well as the arm on the side of the vessel -— may no longer be useable for dialysis access.
We do all we can to prevent dialysis complications.
There is a lot to consider after dialysis access surgery and as you prepare to begin dialysis. We’re here to help at every stage of your dialysis journey. Learn more about what to expect after dialysis access surgery.
