NUTRITION

8.0 Vascular Access for Home Haemodialysis (HHD)

Introduction

There are three types of vascular access for haemodialysis that can be used at home;

• Arteriovenous fistula (AVF).
• Arteriovenous graft (AVG).
• Central Venous Catheter (CVC) – some restrictions apply.

This section will provide information about how to care for your access at home, how to put in the needles (cannulate) and how to reduce the risk of any problems. It does not talk in detail about surgery for access. It does contain pictures of access and needles.

8.1 Importance of good access

Your blood can only be cleaned well on dialysis if your access works well. A strong/fast blood flow and keeping your access infection free help this. Putting the needles in properly is also important. You may do extra dialysis treatments at home which can increase the risk of problems, but good care of your access can reduce this risk.

• Reducing infection risk: Some dialysis centers will test to see if you have bacteria that can cause infections and treat you if needed. Handwashing must be done perfectly and some centers may recommend the use of gloves.
• Checking for infection and blood flow: You will be taught how to check your access for strong blood flow and signs of infection.
• Keeping to the rules. After training many dialysis centers do regular checks on how you put in the needles and care for your fistula.

8.2 Fistulas and Grafts

8.2.1 Arteriovenous fistula (AVF)

An arteriovenous fistula, simply known as the “fistula” is the most common type of access and has the least problems. Ideally it will be put into your non-dominant hand. It is simply the joining of an artery and a vein. The vein gets larger and this is where the needles go into.

8.2.2 Arteriovenous graft (AVG)

Arteriovenous graft simply known as a “graft” is a good option if you cannot have a regular fistula. They are often put in the upper arm, but sometimes the lower arm or the upper leg. A graft is an artificial tube which is joined between your artery and vein.

8.3 Cannulation (putting in needles)

8.3.1 Importance of self-cannulation (Putting in the needles yourself)

The practice of putting in the needles should be started as soon as possible during training as it is often the part of training people are most worried about.  

• By self-cannulating, you will feel in control. You will become an expert of your access.
• If you have problems such as tremor, sight problems, inability to reach puncture sites or even a needle phobia you may need someone else to help with your cannulation at home.

8.3.2 Practical instructions for self-cannulation

You will be taught how to put in the needles. You will also be given all the equipment. Below are some basic steps you will learn.

Preparation

• Cannulate in a clean and draught-free environment with a good light source.
• Do a hand-wash before starting to prepare equipment.
• Prepare equipment such as: disinfectant, drape, sterile dressing pack, tape, syringes, needles, tourniquet, waste bin, sharps container.
• Disinfect hands with an alcohol based rub before aseptic preparation of syringes, needles and tape.

Cannulate

• Wash (scrub) arm.
• Look, feel and listen to the access. Do not cannulate an infected AVF and contact the nurse if you are worried¹.
• Disinfect the access with antiseptic.
• Use a tourniquet for an AVF (optional for button-hole cannulation).
• Stabilise the access and insert the needle.
• Tape with one tape first (to avoid accidental pulling out of needle).
• Check for flashback of blood and flush the needle.

Tape securely to prevent infection and the needle falling out.

Removing needle

• Taking the needles out carefully is important. It has to be done at the right angle and once the needle is out mild pressure needs to be applied for a few minutes².
• When the bleeding has stopped, the sites have to be covered with a small dressing.