This post contains photographs of my husbands arm during a dialysis treatment. If the sight of blood or needles is something you are not comfortable with, maybe this particular post is not for you!
When my husband and I were still dating he came over to my house one evening after a day long trip to the hospital and showed me why he had been there. He was still living with his transplant although his doctors knew it had rejected and it was only a matter of time before he would have to begin dialysis treatments.
Before a patient can begin dialysis, however, there has to be an access point or a point where the blood can be removed from the body a few ounces at a time and then returned. Since arteries and veins are not typically big enough for this job, a vascular access site is created.
There are three types of access points and your nephrologist is able to perform various tests to determine the ideal location and type of access point. The three types are:
- Fistula (arteriovenous fistula of A-V fistula). A fistula is what my husband uses as his access for treatments. To create a fistula you join an artery and vein under the skin in your arm. When joined, the pressure inside the vein increases making the wall of the vein stronger. It is this stronger vein which is able to receive the needles needed for hemodialysis. Generally, it takes up to four months for a fistula to heal and be able to be used for dialysis but it can be used for many years.
- Graft (arteriovenous graft of A-V graft). A graft is also made by joining a vein and artery, however, with a graft these are joined by a plastic tube. This plastic tube is placed under your skin in a u-shaped loop, joining the radial artery to a vein near the elbow. It only takes about three weeks to heal from this type of access but the graft is not generally as long lasting as the fistula. A well taken care of graft can, however, last for several years.
- Catheter. A catheter is used only as a short term access point until one of the above options has healed properly and is ready for use. This temporary access is inserted into a vein in the neck or below the collar bone.
My husbands nephrologist knew he would begin his dialysis within several months and they were able to create a fistula with enough time to heal. When his transplanted kidney finally stopped, his access was healed up and ready for use.
The fistula is a huge, bulging, pulsing tube full of blood. When we lay in bed at night and he has his left arm (access arm) against the bed, I can hear the blood pulsing through with each beat of his heart. I am comforted by this sound, though, because that means this fistula is still working and so is his heart!
I take a great deal of discomfort in the fact that damage to this fistula would be life threatening. The blood pulses through so strongly and quickly, were he to start bleeding out of his access point and not be able to stop it, in a matter of minutes he would have bled to death. A slice to this artery/vein would also be lethal if the damage sliced through the wall. It is recommended that patients with fistulas avoid heavy lifting as damage can cause bleeding. A patient must not allow a medical professional to take his blood pressure, start an IV or draw blood from a fistula.
So, how is the fistula accessed? We know during hemodialysis the blood has to be taken from the patient, cleaned by the dialysis machine and then returned to the patient. This is done with two needles at two separate access points. See the photo below.
This is my husbands arm. The clear tube is where the blood is returned to the body. It is clear in this picture because the blood has not made it through the machine and back to the return point. As you can see, the tube closer to his hand already has blood pumping. The needles are securely taped to the patients arm and this is crucial. Needle dislodgment is one of the top five causes of death among dialysis patients.
The photo below is just after a blood thinner has been injected, the lighter red color indicates the mixture of the blood thinner with the blood.
The final photo is after hook-up is complete and the treatment is underway.
The treatments are four hours long and this is how the access points look for the duration of the treatment. My husband has his favorite nurses which do a wonderful job with sticking him, taping the lines and taping the fistula at the conclusion of his treatments. Dialysis is what keeps him alive and this is the lifeline that connects them!
Stay tuned for much more about our kidney adventures and all the other things we have going on down here at the ranch!!