What Are My Treatment Options for Dialysis?
Unfortunately, kidney failure is typically irreversible. One option is to have a kidney transplant, but even transplant recipients usually must temporarily undergo some form of dialysis. Dialysis is currently practiced in two forms: hemodialysis and peritoneal dialysis.
- Peritoneal dialysis is conducted through a small tube surgically placed in the lower part of your abdomen. Dialysis fluids are regularly introduced into your abdomen and allowed to remain for several hours. Draining the fluid carries away the body’s chemical waste products.
- Hemodialysis removes blood through a needle and cleanses the blood by running it through a dialysis machine. The blood is returned to the body through (in most cases) a second needle. You and your doctor should discuss the treatment options and together decide which is the best course for you.
What Are The Types of Dialysis Access Surgeries?
Hemodialysis requires access to the blood flowing inside your blood vessels so it can be withdrawn and cleansed. However, repeated needle puncture is very hard on veins and arteries. Special surgical techniques must be used to 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, while 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 after this operation, the vein grows tougher and thicker. This fact, plus the increased size, make the vein ideal to use for hemodialysis access.
- 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: Follow your doctor’s orders to prepare for this type of surgery. Those who are right-handed will often have the left arm chosen for surgery — the right arm for those who are left-handed. If a blood test is ordered before surgery, always ask to have the blood drawn from the arm that will not be operated on. In the operating room your arm will be swabbed with antiseptic solution and numbed with a small shot so you will feel no discomfort. You may receive additional medicine to relax you and make you feel drowsy. Antibiotics are given to lessen the chance of infection. In most cases, the entire operation will take about 90 minutes. When the AV graft is implanted, two small incisions are made (AV grafts are commonly placed in the forearm, but they can also be placed in the upper arm or the thigh if necessary). A tunnel is made under the skin to aid in the placement of the graft. One end of the graft is sewn to the artery and the other to the vein. Blood will then flow rapidly from the artery through the graft into the vein.
What Should I Expect During A Hemodialysis Session?
The first step is to make sure that the area where the needle will enter your skin is disinfected. The dialysis technologist should wash the site with soap and water, then rub a special antiseptic solution in a circular motion over the area selected. Once this has been done, don’t touch the area until after dialysis is complete. Remember that the needle breaks the skin, opening a door for infectious bacteria to enter. Absolute cleanliness is required to reduce your chances of infection.
The technologist will then insert the needles through your skin and into the graft or fistula. The needles are taped in place and connected to the lines of the dialysis machine and the dialysis process begins.
When your blood has been sufficiently cleansed of waste products, the technician will remove the needles. To stop the bleeding, the technologist may ask you to hold light pressure with a sterile pad. Use just enough pressure to stop the bleeding — too much force may slow the blood flow through the graft or vein and lead to problems.
What Are Some Reminders About Fistula for Dialysis?
- 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 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 / technologist 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.
What Are Some 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.