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Vascular access

One of the most important steps which must be taken before starting regular haemodialysis sessions is preparing for vascular access – this is the access point on your body where blood will be removed, cleaned and returned to the body during the dialysis sessions. We can provide temporary access for your initial dialysis sessions, but establishing long-term access allows for easier and more efficient removal and replacement of your blood with fewer complications.

The main type of vascular access is the creation of an AV fistula, which is done by connecting an artery directly to a vein, normally in a patients’ forearm during an operation under local anaesthetic.

A fistula is an opening or connection between any two parts of the body that are usually separate, for example, a hole in the tissue that normally separates the bladder from the bowel. While most kinds of fistula are a problem, an AV fistula is useful because it causes the vein to grow large and strong for easy access to the blood system. The AV fistula is considered the best long-term vascular access for haemodialysis because it provides adequate blood flow for dialysis, lasts a long time, and has a complication rate lower than the other access types. If an AV fistula cannot be created, an AV graft or venous catheter may be needed.

In most cases, the operation can be performed on a day-case basis, this means you will come to hospital, have your operation and go home on the same day. However if it is felt that you may need close observation we may plan that you stay in hospital for one night. We will discuss this with you at your appointment.

Vascular access clinic

At Barts and The London Renal Centre, we provide a one-stop vascular access clinic prior to surgery. At this clinic, you will meet our nurse specialist, surgeon and anaesthetist, and you will have a range of tests that are required before the operation. These may include an ultrasound scan on your forearm, a heart ultrasound called an ECHO and a chest x-ray. If the team feels that you are fit for surgery, a date for the operation will be discussed and booked in for you. This will usually be as a “day-case” which means you will not have to stay in hospital.

This clinic is an opportunity for you to ask questions about your operation. Our team will be happy to answer any queries that you may have.

The one stop clinic is managed by a nurse specialist in vascular access.

Clinical Nurse Specialist in Vascular Access
Hanbury Dialysis Unit , East Wing
Royal London Hospital
Whitechapel
London E1 1BB

Tel: 020 7377 2556

Alternatively, contact our main switchboard on tel 020 7377 7000, and ask them to send a message to pager number 07659 122979.

For answers to some frequently asked questions about vascular access, please click here.