Kidney Information & Education

There are a few varieties of hemodialysis accesses-fistula, graft or catheter. The fistula is the most desirable access. It uses your own blood vessels- no plastic or manmade materials. The blood vessels have been re-routed a bit to allow an artery and a vein to be sewn together to form the fistula. After time, the constant pressure from the artery will cause the vein to enlarge. This is good because it allows a brisk flow of blood to flow through the vein. It does take time for the fistula to mature or enlarge. It can sometimes take four months or longer for maturation. You can tell that your fistula is working by feeling for the vibration when you touch it. If you do not feel the vibration you should call your surgeon immediately.

Occasionally, the vein or artery may not be large enough to mature into a fistula. If this occurs then a graft could be inserted. A graft is similar to a fistula except that it is made of plastic. It is inserted between an artery and a vein and acts as the connection. A graft requires a much shorter time to heal and can be used in about a month.

Special care should be taken not to put to much pressure on the fistula or the graft. That includes wearing tight fitted clothing, wristwatches or a purse strap over the area. Also avoid lying on the access arm. Excess pressure can cause clotting in the fistula, which prevents it from working.

The third access is a catheter. It seems to be the easiest of the three types of accesses, however the catheter causes the most problems. Because the catheter is inserted through the skin directly into the blood stream, it allows bacteria from the skin to travel through the blood. This causes bloodstream infections which can be life threatening. Another major problem with catheters is scarring in the vein caused by irritation from the catheter on the lining of the vein. The scarring can be severe and involve all the veins in the neck area. It is important to keep the catheters sterile dressing on at all times.

The word Hemodialysis comes from the word “hemo” meaning blood and “dialysis” meaning to clean. A dialysis machine uses a pump to pull a small amount of blood from the body through special tubing into the “artificial kidney” or dialyzer. Once the blood reaches the dialyzer, the membranes inside the dialyzer filter waste products, extra chemicals and water from the blood. The filtered blood is then returned to the body.

There are three types of hemodialysis. The first is In-Center Hemodialysis. In-Center Hemodialysis involves going to a dialysis center three times a week for four hour treatments. Treatments schedules are either Mon-Wed-Fri or Tue-Thu-Sat. At the dialysis center you will be seated in a reclining chair beside your dialysis machine for the length of your four hour treatment. You will have access to a television with your own earplug. You may also read, write, sleep or perform any other stationary task during your treatment. For safety reasons there is no eating or drinking allowed while dialyzing and family members are not permitted in the treatment area.

The second type of hemodialysis would be Home Hemodialysis. This involves you and a support person being trained by a dialysis nurse how to do your dialysis at home. Your schedule will be dialysis three times a week for four hour treatments. Treatment schedule will be either Mon-Wed-Fri or Tue-Thu-Sat. Training will take approximately 12 weeks to complete. During the training period you will go to the dialysis center three times weekly for your dialysis and training session. Your support person will be trained on how to set up your dialysis machine, how to place your dialysis needles, connecting you to the dialysis machine, running your treatment for four hours, trouble shooting alarms, then disconnecting and cleaning machine at completion of treatment.

The third type of hemodialysis is Home Nocturnal Hemodialysis. It involves the same length of training as Home Hemodialysis. The difference is the length and frequency of dialysis. Nocturnal hemodialysis is done six nights a week for six to eight hours while you sleep. Because you are dialyzing six times a week you will have less dietary restrictions and decreased need for medications as do your three day a week counterparts.

Peritoneal dialysis (PD) has several things in common with hemodialysis. In peritoneal dialysis there is also removal of waste products, extra chemicals, and water. Unlike hemodialysis, PD takes place in the peritoneal cavity. The peritoneal cavity is the part of the abdomen that contains organs like the liver, stomach, and intestines. Dialysis solution is put into the peritoneal cavity. After enough time has passed for dialysis to take place, the solution is then drained. A peritoneal catheter allows dialysis solution to fill and drain from the peritoneum.

PD is close to the natural function of the kidneys. It rids the body of waste products, extra water, and helps balance chemicals in a slow and gentle way. This results in a unique process of on-going dialysis, which is like the action of the normal kidneys. By following your prescribed treatment, your water balance and chemical balance will be more stable.

There are two peritoneal membranes in the abdomen. One of the membranes lines the peritoneal cavity. The peritoneal cavity is in the abdomen and holds organs like the stomach, liver, and intestines. The second peritoneal membrane covers these organs. These two linings make up the peritoneal membrane. The space between these two layers of peritoneal membrane called the peritoneal cavity is large enough to hold the dialysis solution (dialysate) that is used for peritoneal dialysis. There are many small blood vessels in the peritoneal membrane. These small blood vessels are on one side of the peritoneal membrane and the dialysis solution is on the other side of the peritoneal membrane.

Dialysis is the process that cleans the blood of extra water and waste products. Water moves from the area that has the largest amount of water, across the peritoneal membrane, to the area that has the smallest amount of water (most concentrated side). This is called osmosis. With osmosis, the body tries to make the water balance on both sides of the membrane.

There are two ways to perform PD:

1. Continuous Ambulatory Peritoneal Dialysis (CAPD)- Works 24 hours a day. Even while you sleep. It allows you to move freely , just as you normally would. During CAPD, the dialysis solution stays in the peritoneum long enough to pull the extra water and waste products from the blood. This period of time is called the dwell time. After the dwell time has passed, it is time to drain the fluid. When the fluid has drained it is then time to fill your peritoneum with fresh solution so the dialysis process can begin again. Your doctor will determine the amount of fluid he will use during your exchange. The peritoneal cavity has a capacity to hold up to three liters of fluid. Your doctor will decide how many exchanges you should do each day. An example of some exchange times are 7AM. 12 Noon, 5 PM, and 10 PM. Your nurse will help you plan your dialysis around your normal routines instead of changing your routines around the dialysis.

2. Continuous Cycling Peritoneal Dialysis (CCPD)- The principles of CCPD are the same as CAPD except that the dialysis occurs during the nighttime and a cycler machine is used to fill and drain the peritoneum. Your catheter is connected to the cycler machine for 8 to 10 hours each night. The machine fills and drains the dialysate from the peritoneal cavity. The machine continues repeating this process throughout the night. In the morning clean dialysate is left in the peritoneal cavity before you disconnect from the machine. One or two manual exchanges may be prescribed during the day.

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An excellent Chronic kidney disease education program.