Are you aware that some patients live and enjoy life for 10, 20, even 30 years and longer while on hemodialysis? One of my good friends has been on hemodialysis for 33 years! On the other hand, far too many patients develop problems that curtail long life. What makes the difference?
Many patients will experience either an access infection or access failure while on hemodialysis. However, this can largely be prevented if you choose to take charge of your access and its care.
I want to tell you four things I learned to do involving the care of my access that helped me stay healthy for over 17 years of dialysis. My access lasted all those years without a single infection. If you do these things, your access will give you a long, healthful life.
1. Get a fistula.
First, you need the best access. If possible, insist on getting a fistula! NOTE: If you have a graft, you may still be able to get a fistula. Consult with your nephrologist or vascular surgeon.
If you have a temporary neck or chest catheter, it may work fairly well, but patients with a catheter experience an average of 2 infections each year. The tip of a catheter sits inside the heart, so a catheter infection can infect the heart without much in the way of any early symptoms. Catheter infections can also be hard to cure.
If, because of medical complications, you absolutely need a permanent catheter, you should insist that sterile technique is used when you are beginning and ending dialysis, as well as during dressing changes. And always be sure it is covered and clean to reduce your chance of infection.
Except for a few patients who have grafts, the patients I know whose access has worked for a long time have fistulas. If you can get a fistula, it is one way to help ensure that you will live a longer life with fewer access-related problems.
2. Avoid Infection.
As you have probably been told, your access arm needs to be kept clean, and your sites carefully prepped before needle insertion. It is also good practice to wash your arm with antibacterial soap before your treatment. Be sure your needles are kept in their protective sheaths until they are ready to be inserted.
Also, at the end of treatment, after your sites have stopped bleeding, put a drop of betadyne or equivalent over the puncture hole before bandaging.
If your access arm is red or irritated, this could be a sign of infection. Report it immediately!
Why would you stick yourself when someone else can do it? For almost everyone who hasn’t tried it, the idea of self-sticking is scary. But think about it. You actually know more than anybody else about how your own fistula or graft feels and acts. Since no one else has that knowledge, no one else can stick as well as you.
After you have inserted your own needles for about a month, you won’t want anyone else with a needle ever to get near your arm again. Self-sticking means less pain, and properly done, almost eliminates blown sticks and the need for re-sticks. This means you will have a fistula that is like the “Energizer bunny”—it keeps on going and going and going.
4. Feel your access regularly.
One day you will check your fistula or graft and the thrill or pulse will be gone because it has clotted off (mine clotted after 12 years). What to do? Very few patients know the correct answer: get it de-clotted… quickly! Not tomorrow, not after a doctor visit, but right away. The most skilled nephrologist I know feels de-clotting should be done within 12 hours to have the best chance of saving the access.
This means you need to talk now with your nephrologist and with your unit, and find out where you can go that has either an interventional radiologist or a vascular surgeon on call 24/7. That knowledge will allow you, when you do find your access clotted, to be on your way to save it before it is too late.
As you do each of these things, you take more and more control of your treatment and your health. The more you are in control, the more empowered, happy, and confident you will feel. That is the way your dialysis experience should be.
5. Take Care of Your Access:
- Check the thrill or pulse in your access daily
- Have your nurse or technician check your access before each treatment
- Do not use a blood pressure cuff on your access arm
- Do not wear a watch or jewelry on that arm
- Avoid lifting heavy objects or putting pressure on that arm
- Do not sleep with the access arm under your head or body
About the Author
William Dant dialyzed from 1977 through 1994, when he received a deceased donor kidney. His fistula lasted all of his time on dialysis, during which time he had no access infections and no overnight hospital stays. Bill is a weKAN patient activist, an active member in his regional ESRD Network, and a member of the American Association of Kidney Patients.
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