4 Things to Know About Dialysis Access Management
What causes the narrowing (stenosis) of a blood vessel?
In hemodialysis access, there is often narrowing within the blood vessels. There could be narrowing within the arteries and veins. Typically, the veins narrow because of irritation, which is a different entity than the narrowing in the cardiac vessels that you see with atherosclerosis or plaque. The narrowing within the venous system is usually intimal hyperplasia or scar tissue. It can also be extrinsic, which means that if there is swelling or a hematoma forming outside the vessel, the vessel can be narrowed as it is being crushed by the hematoma or swelling. The venous system usually carries blood back to the heart in a low flow and low-pressure system. After a fistula or a graft is created, there is often a high flow or high-pressure system that develops from the arterial flow.
There are also complications from cannulation. Every other day during treatment, the dialysis access is being stuck with needles which can cause trauma to the veins as well. In a graft where the surgeon connects the graft to the native vein, the area of suturing that the surgeon used to stitch the graft to the vein can also have scar tissue, causing narrowing.
What does it mean if I need Dialysis Access Management?
Dialysis access management can either be acute, or urgent when there are problems at the dialysis such as difficult cannulation or pulling clots at dialysis, clotting of the whole access, swelling of the arm, or other complications. Maintenance of the access would be for the life of the access itself, to ensure adequate patency of the vessels, to make sure that there is adequate flow into the vessel and that there was adequate drainage from the fistula all the way back to the heart. Treating the acute symptoms and dialysis access management for the long-term are similar in the interventions where angioplasty or stent placement may be necessary.
What to Expect After Dialysis Access Management Procedures?
In most cases, after Dialysis Access Maintenance or Thrombectomy procedures, the patients will not have too much discomfort. If, however, the vessels are allowed to narrow over time, becoming more critical in nature, more extensive interventions will have to be performed. In those cases some patients may experience some soreness after the procedure, however, after 24 hours those symptoms are usually dissipated. This shows the importance of maintenance of the access; if a patient comes in to maintain the access and make sure that there is adequate flow over time, we can avoid the more extensive procedures and the discomfort that they could have.
How do you access an AV fistula for Dialysis Access Management?
In order to do the procedures for dialysis access, we need to have access to the fistula or the graft. To achieve this, the skin is anesthetized with lidocaine and then a small needle, smaller than dialysis, is used to get into the vein or the graft. Through that needle hole, all procedures can be performed by inserting a wire and placing balloons or stents over the wire if needed. When a procedure needs to be performed, a small suture will be placed after the access is removed. If heparin is not used, that suture will be removed before the patient leaves the facility. However, if heparin is used, such as when a varicocelectomy is performed, that suture will remain in place for one to two days. The suture can then be removed, either at dialysis or the patient can return to the office where it can be taken out.
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