Dialysis/Kidney Procedures Offered by Carson Surgical
For treatment of end stage renal disease:
- Peritoneal Catheters
- Temporary Central Venous Catheters
- Permanent Dialysis Access
Treating kidney failure
What is Dialysis?
Your kidneys remove waste from your blood. When your kidneys fail, they can no longer do this important work. One way to remove the waste is to use hemodialysis. “Heme” (Heem) means ”blood”, and “dialysis” (Di-Al-i-Sis) refers to the process where particles in a liquid are separated on the basis of differences in their ability to pass through a membrane. That is hemodialysis. (He-Mo_Die_Al_i_sis). Hemodialysis cleans your blood by taking it out of your body, passing it through a machine that has a membrane that takes out the waste products then puts it back into your body.
While the actual chemical process of dialysis maybe a topic for your kidney Doctor, the purpose of this article is to discuss how we can create a situation to allow you to get dialysis.
How can vascular surgery help you get dialysis?
In order to be able to do hemodialysis, we need a way to take blood from your body and put it back into your body. In order to perform dialysis, we need to be able to circulate 500 cc (2 cups) per minute of blood through the dialysis machine. The arteries are the thick muscular tubes that carry blood from the heart out to the body. The veins are the thin walled vessels that carry blood back from the body to the heart. The heart does not pump blood back. It only pumps it out and the blood just has to get back on its own. The arteries have more than enough blood flow to allow for dialysis. However, you cannot stick a needle into an artery over and over again; it will damage the artery. You can stick a needle into a vein over and over again and it will not damage it. Unfortunately, there is not enough blood coming back through the veins to run through the machine. (Blood in the veins runs a lot slower.) Therefore, we have to connect the artery to the vein and “borrow” some blood flow from the arteries. Once this is done, we can stick the vein over an over again and borrow this added blood flow through the vein in order to run it through the dialysis machine. The end result is that your blood is cleaned and the waste products are removed. This new situation where we borrow blood from the artery and run it through the vein is called “Dialysis Access”.
Creating Dialysis Access
There are essentially two access procedures. A fistula or a graft.
- A fistula (Fist-u-la) is made by connecting an artery to a nearby vein. Blood flows into the vein and causes the vein to enlarge. It may need weeks or months to develop before it ready and sometimes you need another procedure to help the fistula be ready for use. Fistulas are our best option because the last longer and do not get infected. If at all possible, we create a fistula.
- A graft may be sewn between an artery and a vein if a fistula in not available. Blood flows through the graft from the artery to the vein. A graft is usually ready to use in a few weeks, but may not last as long. We use grafts only if a fistula cannot be created.
Caring for your access
An infection may make the access unusable. If this happens, you’ll need a new access. To help you access last, follow these simple guidelines and any other you’re given.
- Don’t wear tight clothing or jewelry near and around your access.
- Don’t let anyone take your blood pressure on or draw blood from the arm with the access.
- Protect your access from being hit or cut
- Wash your hands often and keep the area around your access clean.
Feeling the “thrill”
If you put your fingers over your access, you should feel the blood rushing through it. This is called a trill. Feel your thrill as often as you are told, usually once or twice a day.
If you can’t feel it, tell your healthcare provider right away. Blood may not be flowing through your access the way it should.
Other problems you should alert your doctor can include:
- Have pain or numbness in your hand or arm
- Have bleeding, redness or warmth around your access
- You access is suddenly bulging out more than usual
- Have a fever over 101ºF
Hemodialysis usually takes 3 to 5 hours. It is usually done three times a week in a hospital or hemodialysis center.