Your doctor has recommended a Vectra vascular access graft as part of your hemodialysis treatment. This section has been prepared to help you and your family learn more about the Vectra graft. If you have any additional questions about the Vectra or your treatment, please ask your doctor or nurse.
Hemodialysis overview
What is vascular access?
Purpose of the Vectra graft
What is the Vectra graft?
Benefits of the Vectra graft
Taking care of your Vectra graft
Frequently Asked Questions (FAQ's)
Glossary
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Your doctor has decided that hemodialysis is the best treatment for your kidney disease. Dialysis treatment cleans your blood using a dialysis solution. The word hemo means blood. During hemodialysis treatment blood is pumped outside the body through a dialysis machine that acts like an artificial kidney. This device removes the extra fluids and wastes and returns the clean blood to the body. People usually go for hemodialysis about three times a week. The average session lasts 3 to 5 hours. When a patient is connected to the machine, he or she cannot really move around. Patients often talk to each other, watch TV, or read to pass the time. Many patients feel a certain sense of community at their hemodialysis centers.
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Vascular access is the method used to access the bloodstream for patients undergoing hemodialysis treatment. Hemodialysis removes blood from the body and routes it to an artificial kidney machine where it is cleansed and returned to the patient. Patients undergoing hemodialysis require easy, routine access to the blood stream. These patients need a vascular access device for dialysis. The most common forms of vascular access devices are:
Arteriovenous (A/V) fistula - A surgeon creates an AV fistula by connecting an artery directly to a vein, usually in the forearm. It requires advance planning because a fistula takes awhile after surgery to develop (generally 1 to 4 months). If immediate dialysis access is required, a central venous catheter is generally inserted until the fistula is ready for use.
Prosthetic Vascular Access Graft (VAG) - A vascular access graft is a synthetic tube implanted under the skin in your arm connected to an artery and a vein. The tube is used primarily to place needles that remove the blood and return it back. Prosthetic grafts are the most widely utilized vascular access devices for long term vascular access in the hemodialysis patient. More than 60% of people receiving hemodialysis in the US have a prosthetic graft. A well-cared for graft can last for several years.
Central Venous Catheter for Temporary Access - An AV fistulae generally takes several months to develop before it can be used. Most synthetic grafts made of PTFE usually can not be used within 2 to 4 weeks after implantation to allow the graft to heal into the surrounding tissue. Patients with an AV fistula or PTFE graft may need to use a temporary catheter if hemodialysis treatments are needed immediately. A catheter is a tube inserted into a vein in either your neck, chest, or leg near the groin. It has two chambers to allow two-way flow of blood. Once the catheter is placed, needle insertion is not needed. Catheters are not ideal for permanent access. They can clog, become infected, or cause narrowed veins.
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The Vectra graft is a vascular access device that is used in patients with end stage kidney disease who require reliable, long-term access to their bloodstream for hemodialysis to replace the work of the kidneys.
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The most frequently used long-term vascular access device is a synthetic graft made from polytetraflouroethylene (PTFE), also known as Teflon. Since PTFE is not elastic, a hole is formed in the graft when punctured with a needle. Therefore, these types of grafts can be used only after tissue growth into the graft. The tissue serves as a plug after needle removal. If dialysis is needed during this healing time, a central venous catheter is generally placed through the skin in the neck into a vein in the chest. These types of catheters have many complications associated with their use and are not recommended for use as a permanent device.
Unlike conventional grafts, the Vectra vascular access graft is made of a biocompatible material called polyurethane. This material and the graft design give the graft seal-sealing properties which means it does not require tissue ingrowth into the graft. It's self sealing ability enables the
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Vectra graft to be used for dialysis almost immediately after implantation since the graft seals itself after needle removal. Its' self-sealing nature also helps stop the bleeding after the needles are removed after the dialysis treatment, allowing you to complete treatment faster than with PTFE grafts.
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In a clinical trial conducted in the US, the Vectra grafts were found to have similar patency (blood freely flowing through the graft) performance and complication rates as the conventional PTFE dialysis grafts. However, there were two primary patient benefits with the Vectra grafts versus the PTFE grafts. These included:
- Ability to start dialysis almost immediately after implantation, often eliminating the need for a central venous catheter. *
- Shorter bleeding time after needle removal allowing most patients to leave the dialysis center quicker than those with PTFE grafts or AV fistulae. *
* Data on file.
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You can do several things to protect your access.
- Make sure your nurse or technician checks your graft site before each treatment.
- Keep your access graft or site clean at all times.
- Use your access site only for dialysis.
- Be careful not to bump or cut your access site.
- Don't let anyone put a blood pressure cuff on your access arm.
- Don't wear jewelry or tight clothes over your access site.
- Don't sleep with your access arm under your head or body.
- Don't lift heavy objects or put pressure on your access arm.
- Check the pulse in your access every day.
- Be sure to follow your physician's instructions for care of the graft until healing of the surgical wound, including:
- Keep the arm elevated
- Keep the incision area clean and dry
- Also follow the instructions of the medical personnel at the dialysis clinic where the graft will be used for dialysis access, including:
- Do not put any pressure on the arm, which may stop blood flow in the graft
- Do not use the graft for other access purposes such as blood tests, drug injections, etc.
- Wash the arm before each dialysis session
Seek a physician's care if you have any of these:
Swelling, redness, pus drainage, fever, spreading bruises at the dialysis needle site, cold, numb, or weak hand.
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Q. Who needs dialysis?
A. More than 220,000 Americans receive ongoing dialysis with approximately 87% of those receiving hemodialysis. Events leading up to the need for dialysis include loss of kidneys due to birth defects, injury or diseases such as diabetes and high blood pressure.
Q. What is hemodialysis?
A. Hemodialysis is the treatment that removes waste products from a patient's bloodstream with an "artificial kidney," or dialysis machine.
Q. Is hemodialysis the only dialysis choice available when kidneys fail?
A. It is one of two dialysis methods available to persons whose kidneys have failed. The other type of dialysis is peritoneal dialysis. This type of dialysis uses the lining of the abdomen to filter blood.
Q. How often do patients need to undergo hemodialysis?
A. Hemodialysis is usually performed about three times every week, each session lasting approximately two to four hours.
Q. Is dialysis a cure for kidney disease?
A. No. If a person's kidneys are temporarily damaged, dialysis can give them a chance to recover. However, if the damage is permanent, a kidney transplant is the only solution to free a patient from dialysis.
Q. Can dialysis patients lead normal lives?
A. While dialysis patients lead normal lives and can travel at will, they can never escape the necessity of dialysis, even having to schedule dialysis sessions at clinics in the towns to which they are traveling.
Q. How does hemodialysis work?
A. For short-term hemodialysis, a catheter is placed in one of the patient's central veins. When hemodialysis procedures are required on a long-term basis, prosthetic grafts or native fistulas are often surgically implanted into the patient's arm to provide a more permanent access point. During dialysis, two needles are inserted into the graft or fistula, one on the artery side and one on the vein side. Blood then drains from the artery into the dialysis machine to be cleaned before being returned into the patient's bloodstream through the vein side of the graft.
Q. What is a prosthetic graft?
A. More than 60% of patients who receive long-term hemodialysis have implanted prosthetic grafts. These grafts are made of a soft tube that joins an artery and vein under the skin.
Q. What is the Vectra Graft?
A. The Vectra vascular access graft is a prosthetic graft that is used for hemodialysis. It is made of a biocompatible material called polyurethane.
Q. How is the Vectra graft different from other grafts?
A. Unlike conventional PTFE grafts which can not be accessed for a period of two to six weeks following surgery, the Vectra graft has self-sealing properties which enable the Vectra graft to be used for dialysis almost immediately after implantation since the graft seals itself after needle removal.
Additionally, its self-sealing design reduces hemostasis time (the time it takes for bleeding to stop after needle removal) in comparison with PTFE grafts.
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Acute renal (REE-nul) failure:
Condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function.
Blood urea (yoo-REE-uh) nitrogen (NY-truh-jen) (BUN):
A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases.
Chronic renal (REE-nul) failure:
Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys.
Dialysis (dy-AL-ih-sis):
The process of cleaning wastes from the blood artificially. This job is normally done by the kidneys. If the kidneys fail, the blood must be cleaned artificially with special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis.
End-stage renal (REE-nul) disease (ESRD):
Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys.
Kidneys (KID-neez):
The two bean-shaped organs that filter wastes from the blood. The kidneys are located near the middle of the back. They create urine, which is delivered to the bladder through tubes called ureters.
Kt/V (kay-tee over vee):
A measurement of dialysis dose. The measurement takes into account the efficiency of the dialyzer, the treatment time, and the total volume of urea in the body.
Nephrologist (nef-RAHL-oh-jist):
A doctor who treats patients with kidney problems or hypertension.
Patency (pa-TEN-se):
A term used to describe the confirmation of adequate blood flow through the graft to allow adequate dialysis.
Renal (REE-nul):
Of the kidneys. A renal disease is a disease of the kidneys. Renal failure means the kidneys have stopped working properly.
Urea (yoo-REE-uh):
A waste product found in the blood and caused by the normal breakdown of protein in the liver. Urea is normally removed from the blood by the kidneys and then excreted in the urine. Urea accumulates in the body of people with renal failure.
URR (urea reduction ratio):
A blood test that compares the amount of blood urea nitrogen before and after dialysis to measure the effectiveness of the dialysis dose.
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