Dialysis and Vascular Access

The kidneys perform functions essential to sustaining life. They continuously clean the blood, flushing out impurities and balancing body chemistry. They also help regulate both blood pressure and the quantity of fluid leaving the body.

In the event that the kidneys fail, either at the final stage of chronic kidney disease (called end stage renal disease or ESRD) or as the result of an acute kidney injury, there are two options to take on the work of the non-functioning kidneys—dialysis, a group of alternatives to cleanse the blood outside of the kidneys, or the transplantation of a healthy kidney into the body.

Types of Dialysis

Hemodialysis accesses the bloodstream through a connection between an artery and a vein, called a vascular access. Blood circulates between that connection and a machine outside of the body to clean the blood. Ongoing hemodialysis can be performed at either an outpatient dialysis center or in an individual’s home, as well as in an inpatient setting if the patient is hospitalized for any reason (visit our Emergency and Hospital-Based Dialysis page for more information).

Peritoneal dialysis circulates a cleaning solution into the lining of the abdomen (called the peritoneum) to clean the blood. The peritoneum is accessed through a catheter in the abdomen.

Learn more about dialysis alternatives on our Patient Education website.

Establishing and Maintaining Vascular Access

Establishing Access

Patients new to hemodialysis must undergo a surgical procedure (usually performed as an outpatient) to establish one of three types of vascular access:

  • Arteriovenous (AV) fistula: A direct connection between an artery and a vein, usually established on the surface of the arm.
  • Arteriovenous (AV) graft: A similar connection using a Gortex-like material to join the artery and vein.
  • Tunneled (subcutaneous) catheter: A connection made through a tube inserted beneath the skin.

New peritoneal dialysis patients must also have access established through a procedure that implants a soft catheter in the abdomen in order to access the peritoneal cavity used to perform the peritoneal dialysis

For patients hospitalized with acute kidney injury, emergency temporary vascular access can also be established using a venous catheter until a permanent access point can be established.

Maintaining Access

Over time, issues can arise at the point of access requiring prompt, skilled medical attention.  Fistula and graft access points can become clotted or fail. Peritoneal dialysis patients may develop problems if their abdominal catheters develop holes or become malpositioned.

The U-M Vascular Access Service: A Lifeline for Dialysis Patients

Michigan Medicine’s Vascular Access Service is a dedicated team of specialists in interventional nephrology, interventional radiology, surgery, and nursing, working together to establish access points for new dialysis patients (a fistula or graft or tunneled catheter for hemodialysis, and an abdominal catheter for peritoneal dialysis) and intervene to repair or replace existing access points when problems arise.

The first point of contact for both patients and physicians are the team’s Vascular Access Coordinators. In frequent contact with both patients and the Interventional Nephrology Unit where procedures take place, these experienced nurses play a vital role in managing patient care plans. They schedule procedures to establish new vascular or peritoneal access, act quickly when procedures are needed to resolve problems with existing access points, and communicate when other specialties when needed for patient care.

The Interventional Nephrology Unit

The Interventional Nephrology Unit (INU) provides comprehensive, state-of-the-art dialysis access support including the following inpatient and outpatient procedures:

  • Angioplasty and thrombectomy procedures to establish or maintain vascular access fistulas and grafts
  • Placement of temporary/emergency (non-tunneled) or semi-permanent (tunneled) hemodialysis catheters
  • Placement of abdominal catheters for peritoneal dialysis
  • Advanced imaging techniques using fluoroscopy and ultrasound to monitor access and identify problems

Connecting with the Vascular Access Service

Dialysis Access Coordinators Lorie Crimmins, R.N. and Amy Schemke, R.N. can be contacted by phone at 734-936-5646 or toll free at 877-MED-INU4 (877-633-4684) from 7:00 am to 3:30 pm Monday through Friday. Voicemail and fax (734-763-3016) are available during off hours to leave referral and contact information.

The INU procedure suite is conveniently located adjacent to the Acute Dialysis Unit on the 7th floor of the University Hospital and is equipped with fluoroscopy and ultrasound to optimize patient safety. The INU is open Monday through Friday, 8:00 am to 4:00 pm, and offers inpatient and outpatient services.