Dialysis access - insertion & removal

Before Your Surgery

• Authorization should be obtained prior to surgery and will be done by the hospital or the rooms staff depending on whether you are an in- or outpatient.

• Make sure that you have been fasting for solid foods for at least 6 hours prior to your surgery and for clear liquids or water for at least 2 hours prior to your surgery. Discuss your chronic medications with your doctor or hospital staff prior to your surgery as you usually are allowed to take chronic medications the day of surgery, barring diabetic medication the day of the procedure. If you are taking any blood thinning medication please discuss these in detail with your doctor as special arrangements need to be made for these.

• Blood tests, clotting profile, kidney function tests, and imaging may be required before insertion or removal.

Day of Surgery

You will be admitted to theatre, the procedure room, or the ward depending on the planned procedure.

 Imaging or X-ray confirmation may be required after placement.

Observation for bleeding after removal.  If AV fistula is created, monitoring of blood flow to the limb the procedure was performed on will be done.

Procedure

Dialysis catheter insertion is performed under sterile conditions, usually in ICU or the ward. The catheter is usually inserted into a large vein in the neck, upper chest or groin and positioned so that it can be used for dialysis.

A tunnelled (permanent) dialysis catheter may be placed under the skin to reduce infection risk and improve stability. This is usually performed in theatre.

Catheter removal is usually performed under local or general anaesthetic. The catheter is carefully freed and removed, and pressure is applied to reduce bleeding.

For long-term dialysis access, a permanent arteriovenous fistula creation is performed, where a vascular surgeon creates a connection between an artery and a vein, usually in the arm.

Procedure Length

Dialysis catheter insertion or peritoneal dialysis usually takes 30–60 minutes.
Catheter removal usually takes 15–30 minutes.
Arteriovenous fistula creation usually takes 1–2 hours, depending on the case.

Possible Complications

• Possible complications include bleeding, infection, bruising, catheter blockage, poor dialysis flow, catheter displacement, blood clots, injury to nearby blood vessels or nerves, pneumothorax, air embolism, recurrence of access problems, and unintended damage to surrounding structures.

Duration of Hospital Stay

• Dialysis catheter insertion is usually a day-case procedure or may require overnight admission depending on your medical condition.

• Dialysis catheter removal is usually performed as a day-case procedure.

• Arteriovenous fistula creation is usually an overnight procedure, depending on the vascular surgeon’s plan.