Hemodialysis (HD) takes some wastes and water out of your blood. Your lifeline on HD is a vascular access. An access is a way to reach your blood to clean it.

There are three types of vascular access for HD:

An arteriovenous (AV) fistula - A surgeon links an artery to a vein under the skin of your arm. A fistula is the “gold standard,” becauseit is made only of your own blood vessels. An AV fistula can last for years—even decades. Fistulas are the access least prone to infections and blood clots. Most people can have an AV fistula. If you have a blood vessel disease, a pacemaker, or other health problems, a fistula may not work for you.

An AV graft A surgeon links an artery to a vein under the skin of your arm with a piece of synthetic or bovine (from a cow) vein. A graft is the second best choice. Since it uses tissue that is not your own, a graft is more prone to infection and blood clots than a fistula. Grafts tend to need declotting procedures and a new one must be placed every few years.

An HD catheter A catheter is a Y-shaped plastic tube. One end goes in a central vein in your chest and ends in your heart. The other two ends come out through the skin of your chest. Or, an HD catheter can be placed in a large vein in the groin. The biggest plus of an HD catheter is that it can be put in and used the same day. But, since catheters are a doorway into your body, the risk of infection—and death—is far higher. And, HD catheters can wear away your vein or cause narrow spots so you can’t have any other access on the same side. Catheters are best used for only a short time when possible.

There are only about ten sites on the body where an AV fistula or graft can be made:

• The lower arm (most common)
• The upper arm
• The leg.

Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinine and urea and free water from the blood when the kidneys are in a state of kidney failure. Hemodialysis is one of three renal replacement therapies (the other two being kidney transplant and peritoneal dialysis). An alternative method for extracorporeal separation of blood components such as plasma or cells is apheresis.

Hemodialysis can be an outpatient or inpatient therapy. Routine hemodialysis is conducted in a dialysis outpatient facility, either a purpose-built room in a hospital or a dedicated, stand-alone clinic. Less frequently hemodialysis is done at home. Dialysis treatments in a clinic are initiated and managed by specialized staff made up of nurses and technicians; dialysis treatments at home can be self-initiated and managed or done jointly with the assistance of a trained helper who is usually a family member

Medical Uses

Hemodialysis is the choice of renal replacement therapy for patients who need dialysis acutely, and for many patients as maintenance therapy. It provides excellent, rapid clearance of solutes