What happens when your access becomes dysfunctional? [Dr. Spinowitz]

Q: What happens when your access becomes dysfunctional?

A: When the access becomes dysfunctional, there can be difficulties at dialysis, and there can be difficulties with your arm. At dialysis, if the flow is too slow then you may have problems with cannulation. The dialysis nurses may not be able to feel the fistula. You can end up with an infiltration, which means that the needle goes through the skin and through the vein into the muscle, possibly causing bleeding, pain, and swelling. There also can be difficulties obtaining adequate blood flow. You could have problems achieving adequate dialysis where the blood is not getting clean enough. There also could be problems with the flow through the dialysis machine, causing clotting of the dialysis.

By using the picture we drew before, we can see all of the possible problems and how they would affect dialysis.

  1. If the blood coming into the fistula is too slow, the dialysis nurse won’t be able to feel it, they won’t be able to cannulate it easily, and you’ll have problems at dialysis with trauma and bleeding under the skin. 
  2. If there’s a narrowing within the venous outflow, pressure will build in the vein and you’ll end up with higher pressure in the fistula. This causes bleeding when the needle is taken out.
  3. You also could end up with aneurysms or bumps along the fistula or the graft. These aneurysms can look like camel humps at dialysis. This happens when the pressure is increased but it doesn’t happen with every fistula. Just because you’re on dialysis doesn’t mean that you need to have these bumps. It just means that you need to make sure that the fistula outflow is open and decompressed and allows for decreased pressure within the access. If any of the, whether at the beginning, where the blood is coming in or within the outflow where the blood is leaving, become too aggressive and shut down the flow, you may end up with a clotted access.

More videos from the interview with Dr. Spinowitz of the Queens Endovascular Center as he describes the details of Dialysis Access Management:

Request a consultation at your nearest American Endovascular center today.