Dialysis, Chemotherapy and You
Dialysis is the process used when the kidneys are no longer able to perform the function of filtering blood and ridding your body of waste and excess fluid. Severe chronic kidney disease that leaves the kidneys functioning at only about 10% to 15 % of their normal capacity requires the help of a machine to perform kidney function and keeps fluids and electrolytes in balance. There are two types: hemodialysis and peritoneal dialysis. Hemodialysis occurs when our blood it put through a filter outside your body, cleaned and then returned to you. Peritoneal dialysis occurs when blood is cleaned inside your body via a special fluid put into your abdomen to absorb waste from the blood that passes through small vessels in your abdominal cavity. The fluid is then drained away. This type of dialysis is typically done at home.
Once your kidney specialist has decided that you need dialysis, Dr. Sidhu will discuss with you the different options for treatment so that the dialysis staff can help you to filter and purify your blood. As part of your care, we will also extensively monitor your treatment to ensure that minimal side effects occur.
VASCULAR ACCESS FOR HEMODIALYSIS
For a vast majority of kidney patients, a vascular access is required for hemodialysis. If access is necessary, the workup to create it will involve a consultation with Dr. Sidhu, along with an ultrasound, to determine the site for creating the access.
When patients find out that they are in the advanced stages of chronic kidney disease and need dialysis, they need to get a fistula or graft to provide easy access hemodialysis. The access needs time to mature before it can be used by the dialysis staff, so it's very important to schedule a consultation with Dr. Sidhu as soon as you are made aware by your kidney specialist that you need dialysis. Dr. Sidhu will work with you and your nephrologist to create an individualized plan that will allow you to maintain your access for dialysis for a long time.
There are two common types of vascular access:
1) AV Fistula
An AV fistula is a direct connection between your artery and vein, usually in your arm. As blood flows to the vein from the newly connected artery, the vein grows bigger and stronger. You must do exercises, such s squeezing a rubber ball, to help the fistula to mature, which takes somewhere from six weeks to four months. Once the fistula has matured, it can provide good blood flow for hemodialysis.
2) AV Graft
Similar to a fistula, an AV graft connects the artery and vein under the skin, except that a man-made tubing connects the artery and vein. It’s about one-half inch in diameter, made from a type of Teflon or Gore-Tex material. They’re usually placed in the arm, but may also be placed in the thigh. Grafts don’t require as much time to mature as fistulas because they don’t need to enlarge. Usually, a graft can be used about two to six weeks after placement. The biggest drawback is grafts usually have more problems such as infections or clotting and may need to be repaired or replaced frequently.
RISKS ASSOCIATED WITH HEMODIALYSIS
As with many minimally invasive procedures, dialysis carries some risks. These include:
- Low blood pressure
- Muscle cramping
- Difficulty sleeping
- High potassium levels
- Pericarditis, an inflammation of the heart membrane
- Bloodstream infections
- Irregular heartbeat
- Sudden cardiac death, which is the leading cause of death in dialysis patients
In the case of chemotherapy, Dr. Sidhu has a special interest in preventing long-term complications associated with the placement of catheters and ports for administering chemotherapy drugs. He will also closely work with your oncology (cancer) team to provide you with access for chemotherapy. Once your oncology team decides you need a port for chemotherapy, Dr. Sidhu will try to get you the port as quickly as possible so that there is no delay in starting your treatment. Once the treatment is finished, the port can be removed to prevent any long-term complications.
Where your catheter and port is placed depends on its type. The port is located completely under your skin. You may feel a small bump, but you will not see the tip of the catheter. The most common types of catheters are:
- Central line, tunneled venous catheter or Hickman catheter, placed in a large vein under the collarbone or in the neck with the tip in the upper chest
- Implantable port or port-a-cath, placed in a large vein in the chest or upper arm with the port positioned just under the skin the same area
Caring for Catheters and Ports
Complications can occur either during implantation or use. Each type has potential side effects and risks that include infections, blockages and clots. Less common problems are a kink in the catheter under your skin or movement of the catheter or port. Taking care of these devices reduces the risk of problems.
Implantation problems include bleeding if the subclavian vein is punctured or a pneumothorax, a collapse of the lung, if your lung is accidentally punctured during insertion.
Infection is a common problem. If the port becomes infected during usage, it may require removal and replacement as an infected port can lead to sepsis, which is a serious, body-wide blood infection. Flushing the port’s catheter periodically with an antibiotic/heparin solution appears to reduce the risk of infection. Securing the port with a method other than sutures may also reduce the risk.
Thrombosis, where a clot develops in the port or catheter, causing it to stop working, is another serious risk. Between 16% and 64% of patients will develop this complication, which may necessitate the port’s replacement.
For comprehensive dialysis access and chemotherapy ports, look to Vein, Vascular, Primary Care & Aesthetic Associates. Serving the communities of Everett, Issaquah, Kirkland, Newcastle, Seattle, Bellevue and Sammamish. We provide high-quality, personalized surgical services focused on you.
When you want personalized, compassionate care that’s unrushed service, look to Vein Vascular, Primary care & Aesthetic Associates. For more information or to make an appointment, call us today at 425-250-9999. For your convenience, you can use our online Request an Appointment form.