Hemodialysis Access: Before Your Surgery

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What is a hemodialysis access?

Hemodialysis is a way to remove wastes from the blood when your kidneys can no longer do the job. It is not a cure, but it can help you live longer and feel better. It is a lifesaving treatment when you have kidney failure. Hemodialysis is often called dialysis.

Before you can start dialysis, a doctor will create a place where the blood can flow in and out of your body during dialysis. This is called the hemodialysis (or vascular) access.

There are two basic types of permanent vascular access.

  • AV fistula: This is the best type of access, but it is harder to create. To make a fistula, a doctor will connect an artery to a vein, usually in your arm. Fistulas tend to be stronger and less likely to get infected than grafts. But they need to be prepared several months ahead of time. After that, the dialysis needles can be put into the fistula.
  • AV graft: This is a good choice if you have small veins or other problems. A doctor will put a tube under the skin in your arm. This tube is the graft. It connects an artery and a vein. The dialysis needles can then be put into the graft. A graft can sometimes be used as soon as 2 weeks after placement.

You will get medicine to numb the area and help you feel relaxed during the surgery. The doctor will make a cut on the forearm of the arm you use the least. This cut is called an incision. The doctor will close it with stitches. The incision will leave a scar that fades with time.

You will probably go home the same day as the surgery. You will probably need to take 1 or 2 days off from work after the surgery.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before surgery?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

  • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
  • Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia.
  • If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
  • Your doctor will tell you which medicines to take or stop before your surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.
  • If you have an advance care plan, let your doctor know. Bring a copy to the hospital. If you don't have one, you may want to prepare one. It lets your doctor and loved ones know your health care wishes. Doctors advise that everyone prepare these papers before any type of surgery or procedure.

What happens on the day of surgery?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be cancelled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
  • Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Do not shave the surgical site yourself.
  • Take off all jewellery and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery centre

  • Bring a picture ID.
  • The area for surgery is often marked to make sure there are no errors.
  • You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.

Going home

  • Be sure you have someone to drive you home. Anesthesia and pain medicine make it unsafe for you to drive.
  • You will be given more specific instructions about recovering from your surgery. They will cover things like diet, wound care, follow-up care, driving, and getting back to your normal routine.

When should you call your doctor?

  • You have questions or concerns.
  • You don't understand how to prepare for your surgery.
  • You become ill before the surgery (such as fever, flu, or a cold).
  • You need to reschedule or have changed your mind about having the surgery.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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Current as of: November 20, 2015