Dialysis and Access Treatment Program
Dialysis requires temporary or long-term blood access sites via one of three types of minimally invasive surgeries.
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Dialysis is a procedure performed routinely on patients who have acute or chronic kidney disease, or end-stage renal disease. Kidney failure is most often irreversible and options are dialysis or kidney transplant. In these patients, their kidneys have stopped functioning as they used to. The purpose of the kidneys are to cleanse the body of waste products, regulate the fluid volume of the body and promote removal of the appropriate amount of electrolytes and chemical substances. The process of dialysis is to do the job of the kidneys by cleansing the blood and removing waste products and excess fluid. In order to be hooked up to the dialysis machine, a blood access site must be created, that can withstand frequent needle puncture; these sites can be temporary or long term.
What are the types of dialysis access surgeries?
There are three types of dialysis access: temporary catheter, AV fistula, and AV graft.
- Temporary Catheter: During this procedure, a thin flexible tube called a catheter is placed into a large vein in the neck. This catheter can be used a maximum of 3 months, so long term dialysis patients will require something else eventually. Also, because this catheter is placed directly into the bloodstream, there is a high risk of infection.
- AV fistula: During this procedure, a small incision is made and an artery and a vein are sewn together. About 6 weeks following the procedure, the vein will increase in size and become thicker and tougher.
- AV graft: During this procedure, two small incisions are made in the arm and a cylinder like tube called a graft is inserted under the skin. One end of the graft is sewn to the artery and the other end to the vein. Again, this increases the size of the vein and it becomes tougher and thicker, with rapid blood flow from the artery to the vein.
How do I know if the graft is functioning effectively?
There are two signs that indicate a dialysis access site is functioning well. When you slide your fingertips over the site you should feel a gentle vibration, which is called a "thrill." Another sign is when listening with a stethoscope a loud swishing noise will be heard called a "bruit." If both of these signs are present and normal, the graft is still in good condition. If not, there may be a narrowing within the graft as a result of blood clot collection. If there is bruising or discoloration close to the graft site, this could indicate that part of the graft wall was punctured and may require repair as well. The site may need to be reopened and repaired, or it may be possible to insert a thin flexible tube called a catheter through the site and use a balloon to widen the opening of the graft and improve blood flow.
What are signs or symptoms I should report?
It is very important to protect your dialysis access site! Do not compress the arm containing the site with tight clothing or jewelry and do not rest anything heavy against it. Remember that it should never be used for routine blood draws, as an IV site for medications or fluids, or as an arm for blood pressure cuff readings. Signs or symptoms that are potentially dangerous and need to be reported include:
- Signs of infection at the access site, such as redness, swelling, or drainage of pus
- A large bruise spreading away from the graft site following a recent dialysis session
- A pulsating hard knot under the skin
- Lack of bruit or thrill
- Coldness, paleness, aching, or tingling in the extremity with the access site
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