Types of Dialysis Access
Tunneled Hemodialysis Catheter Placements (TUN)
We may recommend TUN for patients experiencing problems with their current access site or if they require more than one access site. Multiple arteriovenous fistulas (AFVs) can also work in conjunction with TUNs. It is ideal to have AFVs in two separate locations on the patient's arm, neck, chest, or groin. However, it is not always possible due to the patient's anatomy or medical history.
In some cases, multiple AFVs must be surgically created at the same time as the TUN is placed since patients may be unable to tolerate having surgery done so many times over months or years without some way of eliminating waste products from their body until all surgical procedures had been successfully completed.
Surgical and Percutaneous Peritoneal Dialysis for Urgent Start Programs (PACs)
For patients needing PACs to be placed but do not have time for a hospital stay, we offer urgent start programs that can be done in our office. Our team places the catheter in the patient's abdomen with a needle in one visit. This procedure is called percutaneous peritoneal dialysis (PD).
Our PD program includes pre and post-procedure testing and follow-up visits every three months. The placement of this type of access is typically performed under local anesthesia, which means the patient will not feel any pain during the procedure. Once complete, the patient will be released, as no overnight stay is required.
We also offer surgical placement of catheters for those who prefer this method or require more intensive care following surgery. Surgical placement requires an overnight stay at our medical center, so we may monitor the patient closely until they enter the safe period.
Surgical and Percutaneous (Endovascular) Arteriovenous fistula placements (AFVs)
Surgical and Percutaneous (Endovascular) Arteriovenous fistula placements (AFVs) are permanent access options reserved for patients needing long-term dialysis access. These types of access will remain in place until they naturally degenerate or the patient develops a condition that requires removal, such as embolization or bleeding.
If our team performs a surgical placement, it will be done under general anesthesia so the patient can sleep during the procedure. In some cases, local anesthesia may be used on the leg so the patient may feel pressure but not pain during the procedure.
AFVs involve using a catheter to locate an artery before inserting an access sheath (small tube). Once inserted, the access sheath will remain inside the artery for several days until enough tissue grows around it to create an opening between the patient's artery and vein, which allows blood to flow both ways. Generally, it takes about four weeks for these grafts (openings) to finish forming after the procedure.