| Author | Subject: Re: Access Options |
| Dori Schatell | 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. |