The thing about dialysis is that you need to clean ALL your blood, not just some of it. The best way to do this is to pump the entire body volume through the dialysis cell several times during each session.
To remove and replace that volume of blood over a few hours takes fairly large access holes – about the diameter of coat hanger wire. There aren’t too many places on our bodies where you can poke in needles that thick on a regular basis, so medical science comes to the rescue, and makes one. Or a variety of different ones, depending on the state of your veins and how fast your kidney disease has progressed*.
The most common is the fistula (which I have). It is created by joining a high pressure artery to a low pressure vein on one of your fore arms. This is done by a surgeon under local anaesthetic. The pressure of blood in the artery gradually exercises the vein, which becomes larger and stronger, inflating like one of those sausage balloons (well maybe not quite that much), to create an ideal entry point for the needles.
A couple of things:
It takes months for the fistula to expand enough to be able to be used, so, regardless of your belief that dialysis will never happen to you, bite the bullet. Take your doctor’s advice and get it done early, 12 or even 24 months before you need it. That way you can start on your terms, rather than either holding off until you are on death’s door, or having to put in a temporary access, which is even less pleasant, to tide you over until the fistula is big enough.
I found that psychologically, getting a fistula was a big deal. There is lots of turbulence where the artery joins the vein that results in a whooshing noise and a buzz (called a thrill, though I’ve had better) that coincides with your pulse. In a quiet room you can usually hear it clearly, especially if it’s amplified by what you are resting your arm on. The first time I heard it I felt quite low, realising that I was no longer the pristine me I had come to admire, but rather a permanently modified version. Still, the gloom passed, and now I sometimes use the thrill to amuse small (and not so small) children.
So, now we have access points, how do we get the needles in?
As far as I’m concerned, the best way would be to have some kind of artificial valve system installed, that could be connected directly to the lines on the machine. Seems like common sense to me. Alas, nothing like that exists (yet). It seems there are some difficulties with clotting, infection and worse, though I have not heard of any actual tests…
Anyhow, for the moment, that leaves needles. There are two options, Site Rotation and Buttonholing. We’ll talk about them in the next post.
*I don’t know enough about these to talk of them, I will leave it to others (via comments or if none are forthcoming, via guest posts).