Hemodialysis and peritoneal dialysis require placement of an access site before treatment can begin. There are three types of hemodialysis access options: a fistula, graft, or catheter, which provide the connection to your blood vessels and the dialysis machine. The blood then passes through a special filter, called a dialyzer, which cleanses the blood of toxins. Peritoneal dialysis requires placement of a catheter in the abdomen. This allows a solution called dialysate to flow in and out of the peritoneal cavity. Like hemodialysis, this process cleanses your blood of toxins.

Fistula
A fistula is an access site used for hemodialysis. A fistula requires a surgical procedure to connect an artery and a vein. It is usually created in either your forearm or upper arm. This procedure enables the vein to increase in size and the wall to thicken to allow for increased blood flow. After approximately three months, the fistula will have matured to allow the insertion of needles for dialysis. A fistula is the preferred choice because it usually lasts longer and has fewer problems like clotting and minor infections.

Graft
The graft is formed through the indirect connection of the artery to a vein by a synthetic tube. Grafts are typically used when patients have small or weak veins that will not properly develop into a suitable fistula. It requires minor surgery in which an artificial tube is sewn between a a vein and an artery and is usually placed in the forearm or upper arm. Generally it takes three to six weeks after surgery before the graft is ready to use. The graft is the second best choice for a permanent access.

Catheter
Catheters for hemodialysis are special plastic tubes inserted through the skin, most frequently into a large vein in the neck area. Subclavian catheters are placed into the subclavian vein under the collarbone on the chest. Femoral catheters are placed in the large femoral vein in the leg near the groin. Guidelines recommend that the catheter be used on a temporary basis until a permanent access is ready for use.

Catheters for peritoneal dialysis are special tubing that is inserted into your abdomen during a minor operation. The catheter is about one quarter inch in diameter, and is usually placed about one inch below and to the side of the bellybutton. Just a few inches (2-4) of the catheter remain outside the body and can be easily hidden under clothing.