How many types of dialysis access are there? Patients regret choosing this option the most

No time to make choices and solve problems

Xu’s mother is a typical patient with diabetes and chronic kidney disease. When she was first referred for dialysis, she had a temporary catheter inserted. ?

Although in the later stages of chronic kidney disease, the symptoms of uremia become more and more obvious due to the increasing decline of kidney function. The doctors and nephrology teachers at the hospital also took the trouble to persuade Xu’s mother, hoping that the kidney dialysis pipeline should be established first. ?

At present, there is an established process for the establishment of dialysis pipelines, and the time can be selected. The hospitalization time is 3 days. You will be hospitalized in the evening the day before, and you will have surgery the next day. If there are no complications, you can generally be discharged from the hospital on the third day. . ?

But every time during the outpatient clinic, Xu’s mother always said she would wait until next time. This time it was because her grandson was unavailable, and next time Xu’s father was unwell and needed someone to take care of her. She couldn’t rest. You can’t choose the time even if you choose thousands of things.

The problem will come to you in the end

Finally one afternoon, Xu’s mother collapsed at home and fell into a coma due to excessive urine poisoning. She was rushed to the hospital for emergency treatment because she did not take any precautions in advance. In order to find the pipeline required for kidney dialysis, a temporary catheter was inserted into the groin area for emergency use. ?

After several times of dialysis (kidney dialysis), the person finally became more awake, his appetite became better, and he could eat better. At this time, an autologous fistula was established in the hospital, but because he could not immediately To use it, you need to wait for at least one month for the mature period. Xu’s mother still has to leave the hospital with a temporary catheter in her groin, and temporarily use this tube for treatment three times a week. ?

The journey with this tube was not smooth, because the wound on the tube was large, and it was not attached to the surrounding area of ??the tube, and blood often oozed out. In addition, because it was in the groin area, it occasionally hurt when walking or sitting. It will break into the pipeline. After several times of cleaning, the blood clot will block the blood flow, and the tip hole will be filled with blood clots when it is removed. I had to go back to the hospital and reinsert the temporary catheter in the right neck. ?

I finally waited until the one-month period was up and tried to use the prepared autogenous fistula. Unexpectedly, the blood flow was not as good as expected, so I had to be referred for intravascular balloon dilatation to increase the blood flow. I waited back and forth. It has been more than three months since autologous fistulas became available. ?

During this period, Xu’s mother wore the temporary tube every day and endured the pain and inconvenience. It was not until the moment it was decided to remove the temporary tube that she said with relief: "After a long circuit, we still have to do surgery. Surgery, and it takes so long to be used, I wish I could have done it first and left it alone if I had known earlier!"?

Dialysis (kidney dialysis) requires greater blood flow

Before We have introduced hemodialysis (commonly known as kidney dialysis), which is actually blood washing. Since the process requires a large flow rate and needs to be convenient for injections or receiving treatments three times a week, blood vessels that are generally used for intravenous drips and injections are not suitable. ?

Common vascular accesses used for dialysis (kidney dialysis) include: autologous fistula (AV-fistula), artificial blood vessel (AV graft), permanent catheter (Permcath), temporary catheter (double-lumen) Catheter double lumen catheter). ?

Autologous fistula is the first choice

Autologous fistula is the first choice for patients when their own blood vessels are in good condition. The surgical method is to introduce blood from the patient's own arteries (usually the radial artery or brachial artery) into the veins to fill the blood flow, make it superficial, and make it thick and large enough. ?

Because it completely uses your own blood vessels without any implants, bacteria are not easy to attach, has the lowest infection rate, and has the advantages of long service life. After the operation, the skin is smooth, and there is no problem in bathing and showering. ?

However, because the condition of the patient's own blood vessels plays a major prerequisite, not every patient can have an autologous fistula.

In the United States, patients who enter dialysis generally have poor vascular conditions due to their stout and obese bodies, and the rate of autologous fistulas is only about 14-15. ?

In Taiwan, based on the current data of dialysis patients in clinics, the proportion of autologous fistulas is as high as 81, only 17 are artificial blood vessels, and 2 are permanent catheters. ?

Patients with poor superficial blood vessel conditions can establish artificial blood vessels

If the patient's superficial blood vessels are in poor condition and cannot drain large arterial blood vessels, artificial blood vessels can be used as arteries and arteries. Bridge of deep veins, and then the injection is given to the artificial blood vessel alternately. After the operation, my skin remains smooth and I have no problem taking a bath or shower. ?

But the difference with autologous fistula is that there is an artificial implant after all, so when there is an infection in the body, bacteria may wait for an opportunity to attach, which will slightly increase the infection rate. In addition, because there is only one channel, unlike the veins of autologous fistulas, which actually have branches, it is generally strictly prohibited to tie a tourniquet (band) to stop bleeding after dialysis, because it is easy to cause thrombus in the middle under excessive pressure at both ends. block. ?

The last resort - permanent catheter and temporary catheter

When the patient's objective conditions are not good, such as the vascular condition is really bad, even the deep blood vessels have problems, and artificial blood vessels cannot be established. , or when the life expectancy is short and the physical condition cannot bear anesthesia for a longer operation, permanent catheters and temporary catheters have to be chosen. ?

Although the permanent catheter (Permcath) is named permanent, its actual service life is about 2-3 years at most. After that, the chance of blockage or broken parts increases greatly. The difference from the temporary catheter is that , the catheter does not enter the blood vessel directly, but sneaks under the skin for a certain distance before entering the vein. ?

The advantage of this is that it establishes at least a firewall for bacteria to enter from the surface wound. Compared with the temporary catheter entering the blood vessel directly from the epidermal puncture site, the infection rate will be slightly lower. ?

The temporary catheter is the choice that the above-mentioned patient Xu’s mother regrets most. It is a life-saving catheter that can be administered under local anesthesia when the patient is in critical condition. It has the advantage of being immediately available, but it comes with A bunch of troubles. ?

For example, it may be easily blocked, bleeding from the side of the puncture wound, and the wound may be painful, and the tube may need to be replaced from time to time while waiting for other long-term tubes to be available. ?

Another nightmare caused by temporary or permanent catheters is central venous stenosis. ?

What is central venous stenosis?

Central venous stenosis is the large venous channel entering the heart, which is narrowed due to various reasons. The biggest risk factors are long-term catheter placement and chronic vaginal inflammation. ?

Because the venous return will be affected, it may cause swelling of the upper limbs (Why do the hands swell? - Fistula central vein stenosis). Poor blood circulation, and it will no longer be possible to use autologous fistulas or artificial blood vessels. In the most serious case, Possible amputation. ?

Conclusion

Therefore, if chronic kidney patients in the later stage are expected to enter dialysis in the near future, they should first establish an autologous fistula or artificial blood vessel as a priority to avoid the unjust treatment that some patients have experienced. road and endure unnecessary pain.