Dialysis Access Management
Table of Contents
For patients on dialysis, proper access management in a timely manner is critical. We offer a suite of access management services in an attempt to provide prompt, effective assistance to these patients so that they may continue their treatments.
Dialysis Catheter Placement
In the world of dialysis based on KDOQI guidelines, a fistula is the preferred dialysis access when clinically feasible. However, in certain scenarios, a dialysis catheter may be a necessary bridge to a functional fistula–or it may be the only option in other patients. Both temporary and permanent hemodialysis catheters can be placed by your vascular specialist, but the temporary variety are usually resolved for acute care and hospitalizations because of higher infection rates.
Dialysis Catheter Removal
When dialysis catheters are no longer in use or no longer needed, it is generally recommended by either your kidney doctor or your vascular specialist to have them removed. This is because over time, they can become infected, can cause clot to form or can even completely block the veins from the neck or the arms.
Over time, some patients will develop more chronic complications of dialysis access. A catheter left in the bloodstream for an extended period of time can cause blockages in the veins that make adequate dialysis impossible. Sometimes your vascular specialist will have to do special procedures to unclog these veins and occasionally will require stents to keep them open for a longer period of time.
A fistulagram is a procedure involving the placement of a tiny catheter into your dialysis access and injecting this with contrast or dye. This allows your vascular specialist to see the inner lining of the fistula or graft when using x-rays. This permits the doctor to fix blockages or clotted fistulas or grafts at the same time as diagnosing the problem. Sometimes a fistulagram will involve angioplasty (balloon dilation) or stenting (a permanent metal device implanted in an artery or vein) to keep the vessel open.
Occasionally a fistula or graft becomes blocked or filled with clot. This makes dialysis impossible. This can be managed by performing a fistulagram where the clot is removed and any other problem is fixed. When this occurs, it must be treated promptly to prolong the life of the access. Generally if the fistula is left more than 2-3 days clotted, it may not be salvageable. A dialysis graft can generally be salvaged over a longer period of time.
What is a Dialysis Access Site?
Patients with dialysis have poorly functioning kidneys, so their blood can no longer be filtered normally. Therefore, these patients rely on an external machine to perform this function. In order for this to occur, the machine must connect to the bloodstream, at the dialysis access site. This connection permits the machine to filter salts, proteins and other chemicals.
There are three types of access sites: a fistula, a graft, and a catheter. Fistulas are the most common and long lasting of the options, but require a surgical connection between an adjacent vein and artery, and take several months to mature before use can begin. Grafts use an artificial tube to connect an artery to a vein, but can be functional within two weeks. Catheters are typically used as a temporary access–for example, an access for someone waiting for a fistula to mature, but needs dialysis immediately. Each type of access comes with its pros and cons, and patients should discuss with their doctors which is right for them.
Dialysis Access Site Complications
Unfortunately, even patients who take the best care of their access sites may experience some form of complication. Here are some of the most common access complications:
- Clotting – when this occurs, the access becomes completely blocked and cannot be used without an additional intervention.
- Blockage of the access – typically noticed by decreased flow in the access, prolonged bleeding after dialysis, arm swelling, or incomplete dialysis.
- Any bleeding longer than 20 minutes after dialysis is a reason for alarm.
- Poor circulation in the access arm – numbness, tingling or frankly cold and painful hand. This requires immediate attention from your MD.
- Infection – this can occur at any time during the life of your access and may be noted by redness, warmth or drainage from the access site. This may require antibiotics or surgical correction.
Depending on the complications that arise, there are many forms of treatment options. Fortunately, most complications can be treated in a minimally invasive fashion without open surgery. Click here to learn about what Palm Vascular can do for dialysis access management.