| Author | Subject: Access Options |
| Lori | Posted At 17:13:59 09/10/2001 My father has had 2 fistulas, both of which have failed due to infection. We are going to the doctor on Friday but before then I am trying to educate myself on alternative access options. His doctor mentioned a "tube" that can be implanted that joins the artery and vein with lower infection risk. Does anyone know about this? I've searched the internet for information but it is hard to understand. What happens if a successful access cannot be obtained? He's using a catheter now. Thanks for any support. |
| Dori Schatell | Re: Access Options (Currently 0 replies) Posted At 08:41:56 09/12/2001 Lori, there are 3 main ways to gain access to the blood for hemodialysis. The first is a fistula: a direct surgical connection between the patient's own artery & vein. The vein is closer to the surface of the skin (easier to reach) and the artery has a strong, fast blood supply. Fistulas are the "gold standard" for dialysis access because they are much *less* likely to become infected or clotted, although, clearly, it does happen. The needle holes seal up after each use, and a good fistula can last for decades. The experience of the surgeon creating the access can be important to the success of the fistula or graft. If possible, the fistula surgery should be done by a vascular surgeon who has done many dialysis access surgeries. It sounds as if the doctor is talking about the second form of access: a GRAFT, which is a piece of artificial vein used to connect the patient's own artery and vein. Grafts are much *more* prone to infection and clotting, and the needle holes do not seal by themselves after use. For these reasons, grafts do not usually last as long as a good fistula. Ask the doctor why he believes a graft would be less likely to be infected in your father's case. The third form of access--almost always temporary--is a catheter, a tube that enters a central vein, but remains outside the body. New types of catheters that can be implanted beneath the skin where they are less likely to become infected (e.g., VasCa's "Lifesite") can also be used. Did your father's fistulas become infected during surgery, or when needles were placed for dialysis? Careful technique may prevent either of these cases from happening again. Some patients learn to place needles in their own accesses, to protect their "dialysis lifeline" as much as possible. It sounds as if your dad still has access possibilities for hemodialysis. If he cannot obtain a successful access, then peritoneal dialsyis (PD), which uses the lining of the sac surrounding the abdominal organs to filter the blood, may be an alternative for him, if he is physically suited for it. Please let us know what happens with your dad! We wish him luck and a safe dialysis journey. He's lucky to have a daughter like you to look out for him. |
| Joel | Re: Access Options (Currently 0 replies) Posted At 14:37:35 09/16/2001 I have done both hemo and PD and I would say that if one can do PD by using a cycler (machine that you hook up to by night) you should! It is the best as far as I am concerned. Am willing to give you more info. |
| Julie Weatherby | Re: Access Options (Currently 0 replies) Posted At 10:18:29 11/21/2001 Joel- How do you deal with travel when you have a night-time PD cycling machine? In particular, if I wanted to spend a night or two on a private sailboat, is there some way I could deal with this, do you think? It seems like all the PD supplies would be burdensome when traveling. I find myself wondering whether one could switch to Center Hemodialysis when traveling if one had both types of access. But I'm sure that must be very non-standard and it would be hard to get cooperation from the medical community, I'd think. Another question, how noisy is the machine? I'm afraid it would disturb my husband's sleep. Thanks, Julie (not yet on dialysis) |
| Julie | Re: Access Options (Currently 0 replies) Posted At 10:19:33 11/21/2001 Joel- How do you deal with travel when you have a night-time PD cycling machine? In particular, if I wanted to spend a night or two on a private sailboat, is there some way I could deal with this, do you think? It seems like all the PD supplies would be burdensome when traveling. I find myself wondering whether one could switch to Center Hemodialysis when traveling if one had both types of access. But I'm sure that must be very non-standard and it would be hard to get cooperation from the medical community, I'd think. Another question, how noisy is the machine? I'm afraid it would disturb my husband's sleep. Thanks, Julie (not yet on dialysis) |
| Julie | Re: Access Options (Currently 0 replies) Posted At 10:21:00 11/21/2001 Joel- How do you deal with travel when you have a night-time PD cycling machine? In particular, if I wanted to spend a night or two on a private sailboat, is there some way I could deal with this, do you think? It seems like all the PD supplies would be burdensome when traveling. I find myself wondering whether one could switch to Center Hemodialysis when traveling if one had both types of access. But I'm sure that must be very non-standard and it would be hard to get cooperation from the medical community, I'd think. Another question, how noisy is the machine? I'm afraid it would disturb my husband's sleep. Thanks, Julie (not yet on dialysis) |
| Beth Witten | Re: Access Options (Currently 0 replies) Posted At 15:51:32 02/01/2002 Depending on where people plan to go, whether they're traveling by car or public transportation, availability of space and electricity at the destination, etc. some people choose to take the PD cycler with them while others choose to do daily exchanges manually (CAPD). It is usually easier to arrange for PD supply delivery or to take supplies with you for peritoneal dialysis than it is to arrange to do hemodialysis in a center. A few centers in tourist areas seem to cater to traveling dialysis patients, but most have limited space making it necessary for people to plan at least 1-3 months ahead and require them to be flexible on days and times of dialysis. Ask your dialysis clinic, your local National Kidney Foundation affiliate (www.kidney.org), or your local American Association of Kidney Patients chapter (www.aakp.org) if there is someone you can talk with who uses the cycler. The NKF has People Like Us, Live! classes for people in some NKF affiliates to help people approaching kidney failure understand their options. If you have an opportunity to talk with someone on the cycler, ask about how to set it up, what it feels like to dialyze using it, whether their sleep (or their spouse's sleep) has been disturbed, how they travel, etc. People on a particular treatment are great resources and generally enjoy doing what they can to help new people. |
| Kathleen | Re: Access Options (Currently 0 replies) Posted At 21:48:16 02/11/2002 Ther is a new alternative available for access called "Lifesite" the web site is: vasca.org It's a great device, my friend is starting the process to learn more about it and possibly have one put in. |