Dialysis Access
Services /Dialysis Access
DIALYSIS
Kidneys function to cleanse the body of waste products and regulate the amount of water and electrolytes in the blood. In patients with kidney failure dialysis helps do this, but watching what you eat and drink and following your doctor’s advice about taking medicines are very important. The following information will focus on the dialysis part of your treatment.
Kidney failure is generally irreversible. One option is to have a kidney transplant, but recipients of a transplant usually undergo some form of temporary dialysis. Dialysis is currently practiced in two forms: hemodialysis and peritoneal dialysis.
Peritoneal dialysis is conducted through a Tenckhoff catheter (small tube) surgically placed in the abdomen. Dialysis fluid is introduced into the abdomen, allowed to remain for several hours, and then drained away thus removing the body’s waste products.
In hemodialysis, blood is removed through a needle and cleansed by running it through a dialysis machine. The blood is returned to the body through a second needle. You and your nephrologist should discuss the treatment options and together decide which is the best course for you.
ACCESS SURGERY FOR DIALYSIS
Hemodialysis requires access to the blood flowing inside the blood vessels so it can be withdrawn and cleansed. However repeated needle puncture is very hard on veins and arteries so the following surgical techniques create an area that can be used for repeated blood access:
AV Fistula
One method is the creation of an arteriovenous fistula. In this technique an artery and a vein are sewn together. Arteries carry blood at high pressure away from the heart into every part of the body. Veins collect blood and carry it at low pressure back to the heart. Attaching the artery to the vein causes the vein to balloon out as high-pressure blood flows directly into it from the artery. About six weeks later, the vein grows tougher and thicker. This fact, plus the increased size, make the vein ideal to use for hemodialysis access.
Central Vein Catheter
While still in the hospital, most people undergo hemodialysis using a catheter placed into a large vein in the neck region. Since the catheter is placed directly into the circulatory system, it may provide a route for infection and is not a long- term solution. Central Venous Catheters (CVCs) in place longer than two to three months may lead to complications such as vein narrowing or clotting. Long-term hemodialysis patients will need other, longer-lasting solutions.
AV Graft
The AV graft consists of synthetic tube implanted under the skin, connecting between the artery and the vein, and providing needle placement access for dialysis.
Please click below to continue reading about AV Graft.
NEVER
- Never touch the area where the needle is to enter after skin disinfection or during dialysis.
- Never wear tight sleeves, watches, or bracelets over your graft or fistula.
- Never carry heavy loads against or on the graft or fistula (like purses or shopping bags), sleep on it or have blood pressure taken in the same arm.
- Never use your graft or fistula for routine blood tests (except during a dialysis session) or intravenous drug treatments.
ALWAYS
- Always make sure your arm is washed and clean before each dialysis session.
- Always follow your doctor’s recommendations for maintaining your diet, taking your prescription medicines and exercising regularly.
- Always apply light pressure to stop bleeding after the dialysis needles are removed. Have the nurse / technician check to make sure bleeding has stopped before you leave the dialysis center.
- Always vary needle puncture sites. Follow a “puncture plan” for advancing needle punctures along the length of the graft before going back to a previous site.
TREATMENT TIPS
To help you get the most out of your treatment, here are some tips on how to spot trouble early and to protect your graft or fistula:
Infection
An infection is a very serious condition. Be sure to keep the area surrounding the graft or fistula clean and always disinfect the puncture site. If a needle puncture site has persistent swelling and redness or any drainage, call your doctor.
Only for Dialysis
Do not use a graft or fistula for anything but your dialysis treatments. Your graft or fistula should not be used for blood samples (except during a dialysis session) or intravenous drug treatments.
Diet & Exercise
Maintain your diet and exercise per your doctor’s instruction. You will feel better and the blood vessels that are your lifelines will be more likely to remain functional.
Bruising
A spreading bruise under the skin after the dialysis needle is removed probably means that the bleeding has not stopped. Seek the assistance of your doctor to halt the bleeding.
Hard Knot & Discolouration
A hard knot with black and blue discoloration (figure to right) in any one area of the graft may mean that repeated needle puncture has damaged part of the graft wall. This will need to be repaired. Never allow repeated puncture in the same spot on the graft.
Compress
Do not compress the graft or fistula with tight clothing, bracelets or watches because blood flow might be stopped. Similarly, do not rest a heavy load against it, like a bag of groceries, or sleep on it. And do not have your blood pressure taken in the arm with the graft or fistula because the pressure cuff may stop blood flow.
What are the warning signs that a doctor’s care may be needed?
- Swelling, redness, pus drainage or fever may indicate infection.
- A spreading bruise after completion of a dialysis session may indicate graft bleeding under the skin.
- A pulsating hard knot felt under the skin may indicate graft damage because of repeated needle puncturing in the same place.
- Coldness, numbness, aching or weakness of the hand may indicate that not enough blood is getting to the hand (this is not a common problem).
- No vibration (bruit or thrill) from the graft or fistula may mean blood has stopped flowing through it.