Hemodialysis requires blood to be passed through a filter by using blood vessels prepared for dialysis. There are 3 methods to prepare the blood vessels as follows:
- Insertion of a catheter into a large vein (Double Lumen venous catheter). The insertion site is usually at the neck, shoulder, or thigh.
Patient Instructions for Vascular Access Care
1.1 Be careful to keep the area around the catheter clean.
1.2 Do not let the wound get wet. If it gets wet, come to the hospital or clinic immediately to change the dressing.
1.3 Do not scratch the area around the wound as it may cause infection.
1.4 Avoid wearing pull-over shirts. Wear shirts with front buttons for convenience when removing and to prevent pulling on the neck vessel which may cause bleeding.
1.5 Do not lie on the side where the catheter is inserted.
1.6 For patients using blood vessels in the thigh, avoid bending the thigh as it may cause the catheter to kink, leading to blood clots or impaired blood flow. Also, avoid continuous use of the catheter for a long time as it increases the risk of infection.
1.7 If there is pain, swelling around the catheter exiting the skin, fever, or if the catheter is dislodged, consult a doctor immediately.
1.8 For patients undergoing hemodialysis with a dialysis machine only once a week, they should come to the hospital to change the dressing and clean the skin around the catheter every 3 days.
- Surgical creation of an arteriovenous fistula (AV-fistula), which is a surgery connecting the patient’s own artery and vein, usually done on the arm.
- Surgical creation of an arteriovenous fistula using a synthetic graft, which is a surgery connecting the patient’s blood vessels using a synthetic blood vessel, usually done on the arm.
The appropriate timing for considering vascular access creation is managed by a nephrologist. However, the decision on whether to use the patient’s own blood vessel or a synthetic graft is made by a surgeon who selects the best option for each patient.
Instructions for patients with A-V fistula or A-V graft: This surgery connects an artery, which has higher blood pressure, to a vein, which has lower blood pressure, to increase blood flow to the veins near the skin for use in hemodialysis.
Dialysis Center, Phyathai 2 Hospital, 14th Floor, Building A, Tel. 02-617-2444 ext. 1683, 1684
Manual for Chronic Kidney Disease Patients
