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A provider answers a patient's question in his office.
What will the surgeon do?
Well, in order to perform dialysis,
we need to withdraw blood from your arm at a pretty high rate.
Actually, almost a pint of blood comes out of your arm
and through the dialysis machine and returns every minute.
The best way to do that is to create what's called a fistula.
Now, if we put a needle into one of your own veins,
even if it's a big vein, it would collapse,
trying to draw blood at that rate --
just the same way as if you were
sucking on a straw really hard, it'll collapse.
So we need to create, with surgery,
a way to access your bloodstream,
to get the blood out at that rate
without causing your veins to collapse.
The best way to do that is to create a direct connection
between your artery and your vein,
either in your wrist or up in your forearm.
So what happens is that some of the blood
that would continue down the artery to your hand
gets short-circuited and goes across
this connection that we make and goes into the vein
and comes back up your arm.
That extra blood flow and pressure in the vein
makes the vein get a little bit bigger
and a little bit thicker.
But those changes are enough
to allow a needle to be put into that vein
and the blood to be withdrawn at a pretty high rate for dialysis.
If we can't do that, either because your arteries
and your veins are too small to make that direct connection,
it is possible to have a piece of tubing
put in under the skin -- that's called a graft.
And that makes the same connection
between the artery and the vein.
And when you have dialysis,
the needles are stuck actually into that tubing.
It's better to have the fistula, which is the direct connection
without any artificial materials,
because it will last longer, it's less likely to clot,
and it's less likely to get infected.