Hemodialysis Access: What You Need To Know
Hemodialysis Access: WhatYou Need to Know
Hemodialysis Access: What YouNeed To KnowWhether you already get hemodialysis treatment, or you will need to start dialysis soon,this booklet will help you better understandthe ways to reach (access) your blood forhemodialysis. It tells you: How to choose the access that is bestfor you.About the pros and cons of the different types of access.Why your access is important to getting the most from your hemodialysistreatment.How to care for your access.How to keep your access workingwell.The information in this booklet is based onthe recommendations from the NationalKidney Foundation’s Kidney DiseaseOutcomes Quality Initiative (KDOQI)Guidelines for Vascular Access. You mayalso be interested in checking out the OtherResources section on page 20.2NATIONAL KIDNEY FOUNDATION
What is a hemodialysis access?Hemodialysis is a treatment that removeswastes and extra fluid from your bloodwhen your own kidneys have failed. Beforehemodialysis can be done, a connectionmust be made to the blood inside yourblood vessels. Your hemodialysis access,or vascular access, is a way to reach yourblood for hemodialysis. The access allowsyour blood to travel through soft tubes tothe dialysis machine where it is cleaned asit passes through a special filter, called adialyzer.Are different types of accessavailable?Yes. Three different types of access can beplaced for hemodialysis. They are calleda fistula, a graft and a catheter. Your doctor should teach you about the pros andcons of each one. Your doctor should referyou to a special surgeon with hemodialysisaccess experience at least six monthsbefore you need to start treatment. Thissurgeon will evaluate you and help youchoose the type of access that is best foryou. Once your doctor tells you that youwill need dialysis, you should protect thearm where the surgery will be done. Don’tallow anyone to draw blood or give youan injection in this arm. Also, never let anyone use a cuff to take your blood pressurefrom this arm. You should wear a medicalalert bracelet to inform hospital staff aboutyour arm.NATIONAL KIDNEY FOUNDATION3
A fistula is thebest choice forhemodialysis. It isVeinpreferred becauseit usually lasts lonArteryger and has fewerproblems like clotting and infections.A fistula should beAV Fistulaplaced several monthsbefore you need to startdialysis. This allows the fistula enough timeto be ready when you need treatment.Minor surgery is needed to create a fistula. It is made by connecting a vein toa nearby artery, usually in your arm. Thiscreates a large blood vessel that has afast flow of blood. Your wrist or elbow isthe preferred location for your fistula. Afistula will usually last for many years. Afistula usually takes one to four months to“mature” or enlarge before it can be used.If you are already receiving hemodialysisusing a graft or catheter, ask your doctorabout the benefits of a fistula.VeinArteryGraftA graft is thesecond choicefor an access.Minor surgeryis done usingan artificial tubebetween a veinand a nearbyAV Graft4NATIONAL KIDNEY FOUNDATION
artery. A graft is usually put inside thebend of your arm or in your upper arm.Sometimes, grafts may be placed in yourleg or chest wall. Grafts generally need tobe in place at least two weeks after surgery before they can be used.Catheters aremost often usedfor a temporaryaccess. Forexample, theyare sometimesused for a shorttime in peopleCatheterwho get a fistula and need to start dialysis before the fistula is ready. Once the fistula is “mature,”the catheter will be removed. Sometimesa catheter is used over a long period oftime because a fistula or graft is not possible.Catheters are made of soft plastic tubing.There are two parts, one for removingyour blood and the other for returning thecleaned blood to your body.Catheters are placed only when you needto start dialysis. They are put in a largevein, usually in your neck but sometimesin your upper chest. Catheters have moreproblems (like clotting and infections)than fistulas or grafts. They may not haveenough blood flow for good dialysistreatment.NATIONAL KIDNEY FOUNDATION5
FISTULA PROS AND CONSPros: Lasts longerNot prone toinfectionProvides excellentblood flow once itis ready to useAV FistulaLess likely todevelop blood clotsand become blockedYou can take showers once the accessheals after surgery.Cons: 6Needs to mature one to four monthsbefore it can be usedNeedles are inserted to connect to thedialysis machine.NATIONAL KIDNEY FOUNDATION
GRAFT PROS AND CONSPros: Provides excellentblood flow onceit is ready to useYou can takeshowers once theaccess heals aftersurgery.Cons:AV Graft Lasts less time than a fistula More prone to infection than a fistula Needs at least two weeks before itcan be usedClotting can be a problem that mayrequire surgery or other treatment tocorrect.Needles are inserted to connect to thedialysis machine.NATIONAL KIDNEY FOUNDATION7
CATHETER PROS AND CONSPros: Can be used right awayNo needles are needed to connect tomachine.Cons: Usually a temporary access Most prone to infection May not have the blood flow neededfor enough dialysisMay develop blood clots that blockthe flow of blood through your catheterYou need to wear a protective coverfor your catheter to take a showerCan cause narrowing of major bloodvessels.What happens after my accesssurgery?After your access is placed, you should follow your doctor’s orders about caring foryour new access.8NATIONAL KIDNEY FOUNDATION
Tips for Caring for Your AccessAfter SurgeryFistula: Keep it dry; once it is healed you cantake showers. Watch for bleeding. Take all medicine that is prescribed. Get enough rest. Call your doctor if you:Notice redness, pain, swelling or afeeling of warmth at the access site. Feel short of breath. Have flu-like symptoms. Have a temperature of 99 degrees orhigher. Keep your arm straight and elevated(above your heart) while the access ishealing.Ask the nurse at the hospital to show youhow to check your access at home for avibration (called a “thrill”) or for a sound(called a “buit” pronounced “brew-ee”).Ask your doctor when you can start doingexercises, such as squeezing a rubberball, to help your access mature and beready to use.Your doctor should check your access tomake sure it is maturing properly.Graft: Keep it dry; once it is healed you cantake showers. Watch for bleeding. Take all medicine prescribed for you. Get enough rest.NATIONAL KIDNEY FOUNDATION9
Graft Care — continued Call your doctor if you: Notice redness, pain, swelling or afeeling of warmth at the access site.Feel short of breath. Have flu-like symptoms. Have a temperature of 99 degrees orhigher. Keep your arm straight and elevated(above your heart) while the access ishealing.Ask the nurse at the hospital to show youhow to check your access at home for avibration (called a “thrill”) or for a sound(called a “buit” pronounced “brew-ee”).Catheter: Keep the dressing dry; once healed, youcan take showers using a protective covering over your catheter. Watch for bleeding. Take all medicine prescribed for you. Get enough rest. Call your doctor if you:Notice redness, pain, swelling or afeeling of warmth at the access site. Feel short of breath. Have flu-like symptoms. Have a temperature of 99 degrees orhigher. 10NATIONAL KIDNEY FOUNDATION
What happens when I startdialysis?If you have a fistula or graft, two needlesare inserted into your access at the beginning of each dialysis. These needles areconnected to soft plastic tubes that go tothe dialysis machine. Your blood travels tothe machine through one of these tubes.The blood passes through the dialyzer, orartificial kidney, where it is cleaned. It isreturned to you through the other tube.If you have a catheter, it can be connecteddirectly to the dialysis tubes, and noneedles are used.What happens if my access is notworking well?If your access is not working well, it candecrease the amount of dialysis youreceive. Getting enough dialysis is important to: Improve your overall health. Help you live longer. Improve your quality of life. Keep you out of the hospital.To make sure you are getting the rightamount of dialysis, your dialysis careteam will measure your delivered dose ofdialysis. This tells them if enough wastesare being removed from your blood. Yourdelivered dose of dialysis will be checkedby doing a blood test to measure your Kt/VNATIONAL KIDNEY FOUNDATION11
(pronounced “kay tee over vee”). Anothertest that may be done to measure yourdelivered dose is called URR (urea reductionratio). If you are getting the right amount ofdialysis, your Kt/V should be 1.2 or more.If URR is measured, your result should be65 percent or more. If your numbers aretoo low, your access may not be workingwell.Will my dialysis care team doany tests to check my access?Yes. They should check your access at leastonce a month. Special tests should also bedone. These may include: Measuring flow in your access Measuring pressure in your access An imaging test called duplex ultrasound.Tips for Everyday Care of YourFistula or GraftPrevent Infection Ask your dialysis care team to teach youabout preventing infection and keepingyour fistula or graft working well. 12Wash your access site every day with anantibacterial soap. Ask your dialysis careteam to recommend a good soap to use.Wash access site before every dialysistreatment. Your dialysis center has handwashing sinks and antibacterial soap.Do not scratch your access. Your fingernails could be a source of infection.NATIONAL KIDNEY FOUNDATION
Your nurse or technician should cleanyour access site with an antiseptic beforeputting the needles in. Do not touch youraccess area after it has been disinfected.Your nurse or technician should wear asurgical mask, a face shield and cleangloves when working near your access.Avoid coughing or sneezing on youraccess site during treatment.Always wear a clean glove or use aclean gauze pad if you are holding yourown access site after the needles arepulled.Apply only gentle pressure to stop bleeding after the needlesare removed. Press onlywhere the needle wasand just below. Neverpress above where theneedle was.Call your dialysis careteam at once if the areaof the access is sore, swollen, red or feelshot. This could be a sign of infection.NATIONAL KIDNEY FOUNDATION13
Protect Your Fistula or Graft Do not let anyone measure your bloodpressure on your access arm. Your otherarm should be used instead. 14Do not let anyone take blood from youraccess arm when you are not on dialysis.If the vibration (thrill) or sound (bruit) ofyour access is absent or seems different,call your dialysis care team at once. Thiscould mean the access is not workingwell.Ask your dialysis care team how to makeyour needle sticks as comfortable as possible. They can use different sites for theneedles during each dialysis. Or, if youhave a fistula, a “button hole” techniquecan be used. This uses the same site foreach dialysis, and may be less painful.NATIONAL KIDNEY FOUNDATION
Tips for Everyday Care of YourCatheterPrevent Infection Ask your dialysis care team to teach youhow to prevent infections and keep yourcatheter working well. Be sure your catheter has a clean, drydressing during and after every dialysis. Make sure your nurse or technicianchecks your catheter for signs of infectionat every dialysis.Make sure you wear a surgical maskwhen you are being connected to or disconnected from the dialysis machine.Make sure your nurse or technician wearsa surgical mask, face shield and cleangloves when working near your catheter.Use a protective cover for your catheterto take a shower. Ask your dialysis careteam how to obtain one of these covers.Ask your nurse or technician to teach youor your family how to change the dressing.Keep extra dressing supplies at home incase you need to replace your dressing.Call your dialysis care team right away ifyour catheter cuff is showing.NATIONAL KIDNEY FOUNDATION15
What kinds of access problemscan happen? How are theytreated?Sometimes, even when you take the bestcare of your access, you may have problems. If an infection occurs, your doctorwill order antibiotics for you. If your accessdevelops a clot, it needs to be treatedwith special medications. Sometimes thismedication can be given in the dialysisunit. Other times you may need to go to thehospital for treatment. Sometimes surgeryis needed to remove a clot or repair anaccess. Angioplasy may need to be doneto widen a narrowed fistula or graft. Yourdialysis care team will check your accessfor problems. You, too, can help spot possible problems. Learn the warning signslisted on the chart on page 17. Contactyour doctor or dialysis center right away ifyou notice any of them.16NATIONAL KIDNEY FOUNDATION
Warning Signs of Access ProblemsInfectionWarning Signs:Redness, swelling, soreness and/or afeeling of warmth around your accesssite; fever, chills, and/or achy feeling.Steps to Take:Call your doctor or dialysis care teamat once.You’ll need to take antibiotic medicineprescribed by your doctor.Clotting or poor blood flow inyour accessWarning Signs:Absence of the vibration (thrill) or sound(bruit) at your fistula or graft site;swelling of your arm; lower skin temperature around the access site; a decrease in your delivered dose of dialysis(Kt/V or URR); or changes in other labvalues.Steps to Take:Call your doctor or dialysis center.Keep a record of your Kt/V or URR andother labs. Speak to your dialysis careteam when there are changes.NATIONAL KIDNEY FOUNDATION17
Bleeding from Your AccessWarning Signs:Bleeding from a fistula or graft that lastsmore than 20 minutes after your dialysistreatment is over.Any bleeding from a catheter site orcatheter tube.Steps to Take:For bleeding from a fistula or graft,gently press your access with a cleangauze pad to stop the blood; if bleedinglasts more than 20 minutes, call yourdoctor or dialysis center at once.For bleeding from a catheter site or tube,call your doctor or dialysis center atonce, or go to the emergency room atyour local hospital.Decreased Circulation in YourAccess ArmWarning Signs:Feelings of numbness, tingling, coldnessor weakness in your arm; blue fingers orsores at the tips of your fingers.Steps to Take:Call your doctor or dialysis center rightaway (this must be treated at once toprevent nerve damage in your accessarm).18NATIONAL KIDNEY FOUNDATION
Key Points to Remember Keeping your access working well will helpyou get the most from hemodialysis, andhelp you feel feel your best.If your access is not working well, it candecrease the amount of dialysis you receive.This will affect your overall health and howlong you live on dialysis.A fistula is the preferred type of access. Ifyou are already receiving hemodialysis andyou do not have a fistula, ask your doctor ordialysis care team if you are a candidate fora fistula.Make sure your dialysis care team checksyour access often. They should do somespecial tests to make sure it is working well.Do not let anyone measure your blood pressure on your access arm, or take bloodfrom your access arm when you are not ondialysis. Your other arm should be used tomeasure blood pressure and do blood tests.Ask your dialysis care team to teach youthe steps of good access care to preventinfection and keep your access workingwell.Track your important test results, suchas your Kt/V and your URR. Use theDialysis Lab Log (available by calling theNational Kidney Foundation (NKF) at800.622.9010).Ask your dialysis care team if you have anyquestions about your access or any otheraspects of your hemodialysis care.NATIONAL KIDNEY FOUNDATION19
Other ResourcesContact your local NKF office aboutresources available in your communityand a listing of educational materials andprograms. You can also call the nationaltoll-free number 800.622.9010 or visitwww.kidney.org . The following free NKFbooklets may be helpful: Dialysis Lab Log (11 - 50 - 0224)Dining Out With Confidence(11 - 10 - 0405)Coping Effectively: A Guide for Patientsand Their Families (11 - 10 - 0503)Hemodialysis Catheters: How to KeepYours Working Well (English 11 - 10 0302; Spanish 11 - 10 - 0305)Hemodialysis: What You Need to Know(11 - 50 - 0214) Home Hemodialysis (11-10 - 0329) Kidney Transplantation (11-10 - 0304) 20Choosing a Treatment for Kidney Failure(11 - 10 - 0352)If You Choose Not to Start DialysisTreatment (11-10 - 0330)Nutrition and Hemodialysis(11 - 50 - 0136)Staying Fit With Chronic Kidney Disease(11 - 10 - 0331)Travel Tips for Kidney Patients(11 - 10 - 0513)What You Need to Know About DialyzerReuse: A Guide for Hemodialysis Patientsand Their Families (11-10 - 0335)NATIONAL KIDNEY FOUNDATION
When Stopping Dialysis is Your Choice(11-10 - 0331)Working With Kidney Disease:Rehabilitation and Employment(11-10 - 0501)You may be interested in becoming amember of NKF’s Patient and FamilyCouncil. Membership in the council is free.For more information about the benefits ofmembership and to receive an application,contact the National Kidney Foundation,30 East 33rd Street, New York, NY10016; telephone: 212.889.2210,800.622.9010; Web site: www.kidney.org; e-mail: pfc@kidney.org .NATIONAL KIDNEY FOUNDATION21
TeamMemberNamePhoneNumberNehprologist(kidney doctor)Primary CareNurseDietitianSocial WorkerPatient CareTechnicianAccessSurgeon22NATIONAL KIDNEY FOUNDATION
National Kidney Foundation’sKidney Disease OutcomesQuality InitiativeDid you know that the National KidneyFoundation’s Kidney Disease OutcomesQuality Initiative (NKF-KDOQI) developsguidelines that help your doctor and healthcare team make important decisions aboutyour medical treatment? The information inthis booklet is based on the NKF-KDOQI recommended guidelines for hemodialysisaccess, and it's very important for youto know.Stages of Chronic Kidney DiseaseThere are five stages of chronic kidney disease. They are shown in the table below.Your doctor determines your stage of kidneydisease based on the presence of kidneydamage and your glomerular filtration rate(GFR), which is a measure of your level ofkidney function. Your treatment is based onyour stage of kidney disease. Speak to yourdoctor if you have any questions about yourstage of kidney disease or your treatment.Stages of Kidney DiseaseStage Description12345Kidney damage (e.g., proteinin the urine) with normal GFRKidney damage with milddecrease in GFRModerate decrease in GFRSevere reduction in GFRKidney failureGlomerular FiltrationRate (GFR)*90 or above60 to 8930 to 5915 to 29Less than 15*Your GFR number tells your doctor how much kidney function you have.As chronic kidney disease progresses, your GFR number decreases.NATIONAL KIDNEY FOUNDATION23
More than 20 million Americans—one in nine adults—have chronickidney disease, and most donʼt even know it. More than 20 millionothers are at increased risk. The National Kidney Foundation, a majorvoluntary health organization, seeks to prevent kidney and urinary tractdiseases, improve the health and well-being of individuals and familiesaffected by these diseases, and increase the availability of all organsfor transplantation. Through its 47 Affiliates nationwide, the foundationconducts programs in research, professional education, patient andcommunity services, public education and organ donation. The work ofthe National Kidney Foundation is funded by public donations.Kidney Learning Systems (KLS) A Curriculum for CKD Risk Reduction and CareLightshaded boxes indicate the scope of content targeted in this resource.GFR Glomerular Filtration Rate; T Kidney Transplant; D DialysisThe National Kidney Foundation gratefully acknowledges the support forthese KDOQI Guidelines and Recommendations provided by an educationalgrant from: Amgen, Inc., Baxter Healthcare Corporation, Fresenius USA, Inc.,Genentech, Inc., and Watson Pharmaceuticals, Inc.The National Kidney Foundation gratefully acknowledges the support ofAmgen, Inc., Founding and Principal Sponsor of KDOQI.National Kidney Foundation30 East 33rd StreetNew York, NY 10016800.622.9010www.kidney.orgAlso available in Spanish (11-50 - 0220) 2006 National Kidney Foundation, Inc. All rights reserved.2411-50 - 0216
before you need to start treatment. This surgeon will evaluate you and help you choose the type of access that is best for you. Once your doctor tells you that you will need dialysis, you should protect the arm where the surgery will be done. Don't allow anyone to draw blood or give you an injection in this arm. Also, never let any-
IcC X 3'z-/ FRESENIUS 2008T Ilemodialysis Machine with bibag m System y MEDICAL CARE Special 510(k) Notification D. Device Description The Fresenius 2008T Hemodialysis Machine with bibag System is indicated for use in bicarbonate hemodialysis for acute and chronic renal failure. The 2008T Hemodialysis Machine
hemodialysis patients. In the U.S., approximately 370,000 people rely on hemodialysis care to sustain life. About 75,000 people receive their hemodialysis treatments through central line
Vascular Access strong Primer /strong Vascular access: is the lifeline for dialysis patients. As the name implies, it is the method by which the blood vessel is accessed to get the blood from the patient to the hemodialysis machine for both fluid removal and clearance purposes. There are 3 types of vascular accesses for hemodialysis: 1. Catheters:
Bard Access Systems, Inc. 3 Indications For Use Hickman* Hemodialysis/Apheresis Catheters are designed for long-term vascular access and for use in
HISTORICAL BASIS OF HEMODIALYSIS Acute and chronic kidney failure, which can lead to death if untreated for several days or weeks, is an illness that is as old as humanity itself. In early Rome and later in the Middle Ages, treatments for uremia included the use of hot baths, sweating therapies, bloodletting, and enemas.
4 Dialysis Solutions Hemodialysis The classic hemodialysis is a clinical process for patients with failed or damaged kidney
73 Nimer, Teresita Nabor Hospitalization 74 Villados, Alberto Ocol Medicines 75 Garcia, Cesario Sapitula Hospitalization . Arnold Simeon Hemodialysis 109 Gac-oy, Jemaima Anchay Hemodialysis 110 Jose, Rosendo Hospitalization . 327 Montes, Rafael Palbusa Labs & Meds 328 Tomas, Robert Sakiwat L
launch AutoCAD 2016. Opening an existing Drawing. This tutorial shows you how to add arcs and circles to the subdivision drawing provided with the datafiles that came with this guide. In Tuto-rial 3 you will finish the subdivision drawing so that the final drawing will look like Figure 2.1. Figure 2.1 . POND. N. 10. ECSTASY ROAD . CIRCLE. GARRET BRONWYN ROAD. 9 8 7 6 5 4 3 2 1. Wannabe Heights .
