Kidney disease education, tools & resources
- Vascular Access.
- Tips for Protecting Your Vascular Access
Vascular access is required to obtain blood for it to be circulated through the artificial kidney. There are three types of vascular accesses:
Preferred Access with the fewest complications and lasts the longest.
An artificial blood vessel made of synthetic material used when a patient cannot be given a fistula.
Has the most complications of all access types, and least preferred. Usually used while fistula or graft is maturing.
Hemodialysis requires access to your circulation to obtain the volume of blood needed for this form of treatment to be effective. The veins of your arms are not large enough to allow the necessary amount of blood and to sustain the repeated needling that is needed to continue the treatment. A surgical procedure is needed to create a fistula or place a graft and/or catheter for the treatment to be performed.
Joining an artery to a vein creates a fistula. The pressure from the arterial blood flow to the vein results in a stronger, larger vein that in 6 – 12 weeks-time is capable of handling the treatment. The fistula is commonly placed in the arms but can be placed in the thighs as well. It is the preferred type of access and may last for several years.
A graft is an artificial blood vessel that can be placed by the surgeon anywhere in the body but commonly placed in the arms and upper thighs. The graft is sewn at one end to an artery and at the other to a vein. It may be used 10 to 14 days after placement. Many grafts are made from Teflon as it is a porous material that allows the body’s tissues to grow into the tiny pores. This allows for the graft to be sealed by the body.
A catheter is sometimes necessary at any point while you are on hemodialysis. It is usually inserted in the blood vessels of the neck or groin and can be used immediately. This type of access has a high risk of infection that may include an infection of the heart valves. It is NOT the preferred type of access and should be used for as short a time as possible.
Whatever the type of vascular access you may have, proper care is required to preserve its functioning and to prevent infections. Your healthcare team will instruct you on how to care for your access and how to identify complications.
Tips for protecting your vascular access
- Never sleep on your access arm or allow anyone to sleep in your arm.
- Never wear tight sleeves, watches, or bracelets on your access arm.
- Never carry anything lying across your access arm (such as a purse strap).
- Never carry a load with the hand of your access arm.
- Never let anyone check your blood pressure using your access arm. ONLY dialysis personnel may use your access arm.
- Never let anyone draw blood from your access arm EXCEPT dialysis personnel.
- Never allow tape to go the entire way around your arm in a tourniquet fashion, which may obstruct blood flow.
- Always wash your vascular access just prior to cannulation (insertion of tubing).
- Wear a Medical Alert bracelet or carry a card in your wallet to let healthcare workers know that you are a renal patient and that your veins need to be protected.
I AM A RENAL PATIENT
Important info about my veins:
- NO IVs or blood draws on my RIGHT/LEFT ARM
- If IV or blood draw is required, use my hand veins or my other arm.
- NO BPs on my fistula or graft arm (if fistula or graft in place.
- If a long-term central line is required, use tunneled internal jugular one.
- Use PICC line as last resort
Sometimes even with good care your internal access can develop problems. Here are a few possible problems and some suggestions as to what you can do to help.
SUGGESTION: Check your fistula or graft at least twice a day (morning and evening) for signs of clotting. These include disappearance of the thrill, disappearance or change in the pulsation. Call the dialysis unit if fever occurs.
SUGGESTION: Know the signs and symptoms of infection. These are reddened skin, swelling, warm or hot to the touch, tenderness, and drainage that is different than blood. Call the dialysis unit if this occurs.
Bleeding from the needle sites (Problem)
SUGGESTION: If this occurs; apply pressure immediately with your finger. Have someone help if necessary. If the bleeding does not stop in 30 minutes, continue to hold and go to the emergency room.
SUGGESTION: This occurs during dialysis and is when the insertion of the needle goes into your access wall, slips or is placed outside the access wall into the surrounding tissue. Signs of this are swelling of the access area, burning and/or pain at the needle site. If this occurs, the site needs to be changed. A cold pack will be applied and should continue intermittently for the first 24 hours. Thereafter, apply warm, moist compress intermittently every 4 hours for the next 24 hours.
Notify the dialysis unit, if you observe any of the following:
- Missing sutures
- Catheter further out than before.
- Dressing is off.
- Surrounding site is red or painful.
- Drainage is present.
Protect your catheter:
- Do not pull on the catheter. Take care when changing your clothes.
- Keep the catheter dressing and the area surrounding it dry.
- Do not apply your own gauze and tape unless told to do so.
- Perform your usual activities – do not “baby” your arm on your catheter side.
- Sterile dressing- must be used at ALL times.
- If you have a graft, check for a strong pulse.
- If you have a fistula, check for the buzzing sensation around the fistula. (Remember, we call this a ‘thrill’).
KEEPING HEALTHY WHILE ON DIALYSIS
Your Family Doctor (Primary Care)
It is very important that you continue to see your primary care or family doctor for regular health check-ups and for problems not related to your kidney disease. Let your nurse know if your family doctor has put you on any new medication or has referred you to a specialist. If you see a specialist or have a test done, ask that copies of the report be sent to both your primary care doctor and the dialysis unit.
Changes in Health Status
Let us know if you have any changes to your health status or have been to an Emergency Room or doctor’s office (your primary care doctor or other specialists) between hemodialysis sessions.
We suggest that all patients on hemodialysis get a series of illness prevention vaccinations.
- Hepatitis B – a series of three injections administered over a five (5) month period to prevent liver infection with the Hepatitis B virus.
- Flu Shot – administered once each year during the months of October thru April to prevent or lessen severity of the flu.
- Pneumovax – administered once every five (5) years to prevent pneumonia.
It is important to maintain your dental health. See your dentist for regular check-ups. Get any dental problems treated as soon as possible. Make sure you tell your dentist that you are on hemodialysis. You may require antibiotics to manage any dental infection.
As you age or if you have been diagnosed with a chronic non-communicable disease such as hypertension or diabetes, you are strongly encouraged to have an annual eye examination.
Staying Healthy Tips
Following the advice of your doctor and other members of the healthcare team will help you to stay well. For best results, you should
- Take your medications as ordered
- Inform team members as soon as you feel unwell
- Follow your renal diet
- Get rest and exercise to help you feel better and more energetic.
Exercise is important to everyone who wishes to stay fit and healthy, and that’s especially true when you have ESRD. You may say that you’re too sick, tired or weak to exercise, but in fact, exercise may be just what your body needs. Exercise helps keep your muscles from becoming weak and joints from getting stiff. Studies have shown that no matter how old you are, exercise can make you stronger and give you more energy. People on dialysis who exercise may feel better and have a greater sense of control over their lives. There are numerous other benefits too.
- Helps to maintain or decrease your body weight
- Increases strength, endurance and flexibility
- Keeps your heart healthy
- Improves your sense of well-being
- Lifts your mood and helps fight depression
- Helps control blood pressure (you may even be able to cut down on blood pressure medication)
- Lowers blood sugar (if you are diabetic)
- Reduces your risk of having a heart attack
- Helps you sleep better
- Keeps your bones healthy
You should check your doctor before starting an exercise program to see if there are any limitations or suggestions. Your doctor can help you develop an exercise plan, taking into account your physical needs and abilities. Exercise will play a big part in living a better, healthier, more satisfying life.
Patients should always check with their doctor before beginning new exercises and activities.
Kidney failure does not hinder you from having a healthy marriage or meaningful relationships. Staying intimate with those you love is important and something everything everyone needs. Sexuality does not refer only to sexual intercourse but includes things like hugging, kissing, or touching. Many things can affect your sexuality, such as hormones, nerves, energy level, even medications. Don’t be afraid to talk to your healthcare team about sex.
Depression and Kidney Disease
Adjusting to the effects of kidney failure and the time you spend on dialysis can be difficult. Aside from the ‘lost time’, you may have less energy. You may need to make changes in your home and work life, giving up some activities and responsibilities. Keeping the same schedule you kept when your kidneys were working can be difficult now that they have failed. Accepting this new reality can be very hard on you and your family. A counselor or social worker can help you cope.
Many patients feel depressed when starting dialysis, or after several months of treatment. If you feel depressed, you can talk with your social worker, nurse, or doctor. This is a common problem that can often be treated effectively.
Your treatment should do more than just keep you alive. It should also give you the best quality of life possible. Don’t assume that you have to live with fatigue and pain. Talk with your healthcare team, so they can help you get the most from your treatments.