Dialysis Access

Problem: Kidney Failure

The kidney’s main job is to clean the blood. They do this by removing waste products and excess fluid from the blood. The kidneys also balance certain chemicals found in the blood that are necessary for survival. They have a few other jobs as well, such as telling the body to make red blood cells, managing blood pressure, and helping keep bones strong.

When the kidneys fail, the blood is no longer being cleaned. Waste and excess fluid buildup in the blood, and chemicals become out of balance. This can lead to being ill and even cause death if left untreated. Kidney failure does not have a cure, but there are treatment options that help keep the body working the best it can.

 

Treatment: Dialysis

Dialysis is a treatment that filters the blood one of two ways: hemodialysis or peritoneal dialysis. Hemodialysis uses a manmade filter in a machine to clean the blood. The blood travels from the body to the machine, is cleaned, and is then returned to the body. Peritoneal dialysis is a blood cleaning method that uses the natural lining in the abdomen. A fluid is placed inside the abdomen that works with the lining to filter the blood.

 

Hemodialysis

Hemodialysis uses a filter known as a dialyzer to clean the blood. Blood flows through the dialyzer past a special membrane. The membrane separates the blood from dialysate found on the other side of the membrane. This membrane allows waste products and excess fluid to pass through it, but blood and dialysate cannot pass through so they do not mix. Dialysate is a special fluid that pulls waste products and excess fluid out of the blood. By the time the blood reaches the end of the dialyzer and is about to be returned to the body, the waste products, extra fluids, and chemicals have been removed and the blood is clean.

The blood that goes through the dialyzer is drawn and returned from a special blood vessel called an access. There are different kinds of access – a fistula and a graft.

 

  • Fistula: A fistula is made by connecting a vein in the arm to a nearby artery. Blood then flows rapidly from the artery into the vein. Over time, this enlarges the vein, allowing for easy access. A fistula may take a while to develop, so it may be weeks or months before it can be used for dialysis.
  • Graft: A graft is a piece of manmade tubing that is sewn between and artery and a vein, usually in the arm. Blood flows rapidly from the artery through the tube to the vein. Grafts are usually ready to use for dialysis in a few weeks.

 

Hemodialysis is almost always done at a dialysis center by medical personnel, but in some cases it can be done at home. It is done several times a week, usually on Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday.

If it is determined that you are a good candidate for hemodialysis access, you will have surgery where Dr. Robbins will create either a fistula or a graft. Dr. Robbins will closely follow the development of your access, making sure it is a good access site for hemodialysis.

One characteristic of a hemodialysis access is a thrill. The large blood volume passing quickly through the access can be felt through the skin. It feels like a vibration. If for some reason you can’t feel the thrill, call us right away.

Risks and Complications

Some of the complications that are possible with hemodialysis are:

·      Low blood pressure

·      Infection

·      Blood loss

·      Allergic reaction

 

Peritoneal Dialysis

Another type of dialysis, peritoneal dialysis (PD) uses a natural membrane inside the abdomen and dialysate, a special solution, to clean the blood. The natural membrane is called the peritoneal membrane. This membrane lines the abdominal cavity, holding organs such as the stomach and intestine where they should be. When the abdominal cavity is filled with dialysate, the membrane and the dialysate work together to clean the blood. Dialysate fills the abdominal cavity through a tube called a catheter. The catheter is usually permanent, and it is placed near the bellybutton. The dialysate solution needs to be changed several times a day, a process called an exchange. Every few hours, the dialysate is drained out of the abdomen through the same catheter, and fresh dialysate can then fill the abdominal cavity again.

Peritoneal dialysis can be done at home or work, and exchanges take around 30 minutes. One type of PD is continuous ambulatory peritoneal dialysis, or CAPD. For CAPD, exchanges are done every 4 to 6 hours during the day. A second type of PD is continuous cyclic peritoneal dialysis, or CCPD. For CCPD, a machine called a cycler does most of the exchanges at night while you sleep.

If you are a candidate for PD, you will have a surgery where Dr. Robbins inserts the catheter used to make the exchanges. This catheter is permanent and is usually only removed with infection or if another treatment is chose over PD.

Risks and Complications

Some of the complications that are possible with peritoneal dialysis are:

·      Peritonitis (infection inside your abdomen)

·      Blockage of the catheter

·      Infection of catheter site

·      Blood sugar problems (if you have diabetes)

 

Preparing for Your Procedure

You will be told by our office how to prepare for your procedure. This includes special instructions about medications. Be sure to follow the instructions we give you, or your surgery may have to be canceled.

A Week Before

  • Tell us about any allergies you have.
  • Tell us about any medications you take, including prescriptions, over-the-counter medications, supplements, and herbs.
  • Make medication changes as we direct you. This can involve stopping certain medications you normally take or starting certain medications before surgery.

The Day Before

  • Don’t drink or eat after midnight the night before you surgery. Do not smoke, chew tobacco, or chew gum after midnight. If you were instructed to continue any medications, take them with a sip of water only.
  • Arrange a ride home for when your recovery is finished.
  • Follow any special instructions we give you.

The Day of the Procedure

  • Arrive on time to the hospital.
  • Bring all medications you take with you to the hospital.
  • Hospital staff will prepare you for the procedure.

Recovery

            After your procedure, you will probably be discharged the same day. Once you return home, your recovery should take about a week. Be sure to schedule a follow-up with our office two weeks after your surgery. Here are some guidelines to follow during your recovery:

  • Keep the incision or puncture site clean and dry.
  • Take medications as prescribed.
  • Do not drive until cleared to do so.
  • Avoid lifting objects more than 10 pounds for a week or otherwise instructed.