Dialysis and Dialysis Access
Robert Wood Johnson University Hospital (RWJUH) provides quality and timely surgical care for all patients requiring new dialysis access and for those patients having urgent access issues, such as those requiring a revision or “declotting” of an access fistula or graft. Inpatient dialysis services are available for those requiring a 24-hour stay or immediate post-procedure dialysis.
Care related to dialysis access may be performed by members of the transplant or vascular surgery team.
Hemodialysis
With hemodialysis, the blood is cleaned and filtered with an external dialysis unit. For patients who choose hemodialysis, our surgeons attempt in all cases to provide a functioning arterial-venous fistula (AVF). Blood is taken from and put back into the body from either an AVF or arterial-venous graft (AVG), which is constructed in the arm by a surgeon.
A fistula is created by connection of a vein to an artery. In time, the vein grows in diameter, and becomes large enough to accommodate the high flows required for adequate dialysis treatments. A well maintained fistula can last for several years with little long term complications.
An AVG, which is a plastic tube that is inserted under the skin, has a higher infection and clotting rate and a shorter lifespan than an AVF. National guidelines for maintenance of hemodialysis access recommends that greater than 60% of all patients have an AVF as their primary access. Our goal is to reach approximately 90%. Through our use of the vascular lab for pre-operative and post-operative assessments, we are able to successfully construct and maintain AVFs for the majority of patients.
Vascular surgeons at RWJUH perform the following hemodialysis procedures:
- Pre-operative venous mapping
- Pre-operative arterial PVR/Duplex evaluation
- Diagnostic Angiography – Pre and Post Procedure
- Diagnostic Venography – Pre and Post Procedure
- Construction of primary AVF/AVG
- Surgical revision of AVF/AVG
- Thrombolysis/Declotting of AVF/AVG
- Angioplasty of AVF/AVG
- Stenting procedures venous obstructions
- Insertion of peritoneal dialysis catheter
- Insertion of temporary catheters
- Insertion/revision of long-term dialysis catheters (Permacath)
Peritoneal Dialysis
The other type of dialysis is peritoneal dialysis. For those patients, it is the peritoneum, or inside lining of the abdomen, that performs the cleansing of the body’s waste products. Patients that are maintained on peritoneal dialysis require a catheter to be placed into the abdomen for fluid exchanges. These catheters are typically placed into the abdomen under local anesthesia.
Placement of a peritoneal catheter is typically performed by transplant or general surgeons.
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