Services

Sahel Health is currently providing the following access services in collaboration with Nyaho Medical Centre (NMC) and St. Michael’s Specialist Hospital (SMSH).

• Central Venous Catheter (CVC) Insertion
• AV Fistula Creation
• AV Graft Creation

Central Venous Catheter (CVC) Insertion

A Central Venous Catheter used for haemodialysis is a tunnelled catheter - it is placed under the skin. There are two types of tunnelled catheters: cuffed or non-cuffed. The CVC is placed under the skin and into a large central vein, preferably the internal jugular vein, to enhance rapid transportation of blood flow from the body to the dialysis machine.

Non-cuffed tunnelled catheters are used for emergencies and for short periods (up to 3 weeks). These catheters are typically placed either in the neckline or femur.

Tunnelled cuffed catheters, a type recommended by the National Kidney Foundation (NKF) for temporary access, can be used for longer than 3 weeks when:

• An AV fistula or graft has been placed but is not yet ready for use.
• There are no other options for permanent access. For example, when a patient’s blood vessels are not strong enough for a fistula or graft.

Catheters have two openings inside; one is a red (arterial) opening to draw blood from your vein and out of your body into the dialysis pathway, and the other is a blue (venous) opening that allows cleaned blood to return to your body.

Here is a link for additional information on CVCs: Hemodialysis Catheters: How to Keep Yours Working Well | National Kidney Foundation

The CVC procedure is conducted by a Sahel Health Nephrologist or trained ER physicians at Nyaho Medical Centre (“NMC”); the procedure is conducted in the theatre at NMC.

AV Fistula (AVF) creation

An AVF is the “lifeline” of a dialysis patient. It is a surgery that creates a connection between an artery and the vein for haemodialysis. It is mostly done in the upper limbs. It is usually done on the non-dominant arm of the patient. A short circuit is made between the artery and the vein so that blood will flow fast enough for needles to be placed into the fistula on a regular basis. Blood is withdrawn from the fistula, passed through an artificial kidney machine, and then passed through a needle back into the fistula.

After the construction of the AVF, it is ready to be used at least six to eight weeks from the day of surgery. The AVF is typically created a couple of months prior to needing dialysis so that the vein can enlarge under the pressure of the blood coming from the artery.  Medical research also confirms that the creation of the AVF at least 4 months before starting dialysis was associated with the lowest risk of sepsis and death.

Delay in AVF placement leads to increased reliability on catheter access which contributes significantly to morbidity and mortality.

Through this 6-to-8-week period known as the “maturing process," the vein must enlarge to a sufficient size that needles can be placed into it for an adequate blood flow rate on dialysis (usually 500 to 600 millilitres per minute). 

An AVF, when compared to an AV Graft or a catheter access for haemodialysis is associated with a lower risk of infection, blood clots, and a longer life expectancy on dialysis. A well-created fistula that is well maintained will always result in a greater life expectancy than any other vascular access for dialysis. 

The AVF procedure is conducted by a Vascular Surgeon contracted by Sahel Health, with the procedure conducted in the theatre at any of our partner facilities – Nyaho Medical Centre (NMC) or St. Michael’s Specialist Hospital (SMSH).

AVF Maintenance

Post-surgery, there is a need for regular review of the AVF by the Vascular Surgeon.

Sahel Health will typically schedule a quarterly review of the AVF for the haemodialysis patient.

Here is a link for additional information on AVF access: Hemodialysis Access | Fistula, Graft, & Catheter National Kidney Foundation

AV Graft (AVG) Creation

An AVG is like an AVF except that a soft manufactured tube is used to join an artery and vein in the arm. The artificial tube is called a "graft,"  and the needles are placed into the “graft” during the haemodialysis process.