Dialysis is the most common treatment of kidney failure. The kidney’s filter the blood of toxins, control blood pressure, and excrete urine. Conditions that interfere with blood flow to the kidneys can result in renal failure, either suddenly (acute) or gradually (chronic).
When the kidneys no longer support functions the body requires, it can be dangerous and life threatening.
Patients can be placed on dialysis, an entranceway into the bloodstream that lies beneath the skin. This artificially allows blood to be cleaned of impurities and returned quickly, efficiently, and safely. This usually requires sessions up to 3 times a week.
Before choosing your access site, some diagnostic testing will be performed. A non-invasive test is used to evaluate the blood flow in your arteries. This involves the use of blood pressure cuffs placed at intervals on your arms.
Ultrasounds are done to check vein sizes in both arms. Access sites will not be placed in areas with reduced circulation because blood flow will be insufficient, therefore sites are usually placed in the arms.
We try to place sites in your non-dominant arm. Exceptions include a pacemaker on that side or inadequate vein sizes.
The 2 most common causes of renal disease are high blood pressure and diabetes. Several others include hardening of the arteries causing occlusion or blockage to the kidney, infections or immunologic factors.
Vascular Access should be prepared weeks or months before you start dialysis. The early preparation of this will allow easier and efficient removal and replacement of your blood with fewer complications. If you have had your testing done and it is decided where your access site will be, you shouldn’t allow any IV’s or blood draws on that arm so your veins aren’t scarred from frequent punctures.
Also your lab values will frequently be monitored for your kidney function. These are called BUN and CREATININE. Normal values are: BUN – 7-18 CREAT – 0.6-1.5
Minimally Invasive Treatment
You should take some steps in caring for your access area after your procedure.
- Initially keep your arm elevated to reduce pain and swelling.
- Keep area clean and dry – no soaking for the first 2 days.
- Use area for dialysis access only.
- No blood pressures taken on that arm.
- No jewelry or tight clothing to that area.
- No sleeping with access arm under your head or body.
- Minimize lifting heavy objects.
- Check your pulse frequently.
Some pain and edema is common, but report if the pain is not decreasing and report any bleeding, drainage and temperatures over 101.
Initial numbness and coolness in the hand goes away in a few weeks, as your circulation compensates. However, if it becomes severe or doesn’t diminish, call the office immediately. This may be a condition called “steal syndrome” where the fistula is causing too much blood to flow AWAY from the hand.
Squeezing exercises are used to grow and strengthen your fistula to make your dialysis faster and easier.
Creating the access portal is a minor surgical procedure. There are two types of portals that can be placed completely under the skin.
Fistula: your vascular surgeon constructs this by joining your artery to your vein.
Graft: a man-made tube, usually plastic, that your surgeon inserts under the skin to connect your artery and vein.
These connections increase blood flow through the vein. In response, your vein stretches and strengthens. After surgery, the fistula begins maturing where it increases in size and looks like a cord under the skin. The process can take 3-6 months. You may be asked to return to the office for an ultrasound to check the flow rate. Once matured, it should be ready to use. If you need to start dialysis immediately, a temporary catheter can be placed in the neck, chest, or groin. These are not ideal for permanent access as they can clog or become infected.
Fistulas are preferred to grafts since they are constructed of your own tissue, which is more durable and resistant to infections. However, if your vein is blocked or small, grafts provide good alternatives. Grafts mature quicker but usually last 1-2 years, whereas fistulas last around 3-7 years.
Typically this is done as outpatient basis. You will be sedated and in some cases put to sleep. Instructions will be given prior regarding food, drink and medications.