Access to Access
Me and Dialysis
For those that have been following my posts you know that I lost my kidneys to Lupus Nephritis and that I am on dialysis. Dialysis is a form of kidney replacement; I lost the function of my kidneys and therefore required treatment three times a week.
The first thing I want to say is that dialysis is a substitute but no way like the real thing and that there are a few downers associated with it. The first is that you cannot travel as easily and as much as you would like and second you have to be very conscious of what you're eating and drinking. I do pretty well as I'm very careful with my fluid intake and monitor my numbers very carefully. As I said in an earlier post we must take control of our own health and be proactive about; so most people can't even tell I'm on dialysis.
I also take care of my fistula (the access created for treatment) so I don't have the huge bumps that are usually associated with people on dialysis. The access is very important for obvious reasons. It is very important to make sure that your not be stuck in the same place every time, that its clean and disinfected before every treatment and that you're watching for redness or extra pain; these can be signs of infection and because a vein is connected to an artery it can be life threatening.
There are three forms of accesses in the world of dialysis first there is the permacath. This is a temporary catheter placed in the chest which accesses the large artery in the neck for dialysis, This type of catheter is used while and AV Catheter matures or graft is put in. This type of access is temporary as it puts a person at risk for infection and also the skin often breaks down from the foreign material (tubing) very quickly. Also, permacaths do not ensure proper dialysis as the blood has to be set to run very slowly due to its location. Generally blood flows should be from 400-600 (on the machine) depending on body mass. With catheters that is taken down to a bit over 300; that's 300 per hour compared to maybe 600 per hour, meaning 50% of the blood is getting cleaned.
The second type of access used is a graft. An Arteriovenous graft is used in approximately 25% of the dialysis population. It is better then a permacath as it decreases the risk of major infection. However, the graft can cause significant complications as it can easily develop clots as it is foreign material being placed in the body. AV grafts are created in those that have poor veins. Upon finding NO suitable veins to attach to an artery a vascular surgeon creates one using GORE-TEX (type of tubing) and
The last and first choice of all vascular surgeons is the Arteriovenous Fistula (AV Fistula); also referred to as the "gold standard". An AV Fistula minimizes the risk of infection and risk of clots since there is no foreign being used. It allows for a clean blood flow and though it requires maintenance it is much less problematic.