- Do dialysis patients need the help of Cardiovascular Surgery Specialists?
Yes, kidney failure patients need dialysis in the last period when they need the procedure called hemodiafiltration. must be connected to the machine. They need a vascular access line for this procedure. This vascular access is provided by Cardiovascular Surgeons.
- Can we open it up a little?
The dialysis machine works under certain pressures for certain periods of time. They filter large amounts of blood with a kidney-like mechanism and pump it back to the body. There must be a vascular access that can provide this process. Catheter and fistula are among the most important vascular access routes. If the patient will be on dialysis within days, catheter insertion is performed; if the patient will be on dialysis after more than 3 months, fistula (arteriovenous fistula -AVF) operation is performed.
- Catheter insertion. What kind of process is it?
In order for the dialysis machine to work, the blood from the patient's body must be transferred to the machine at a certain pressure and amount after taking the necessary precautions, and after being cleaned, it must be returned to the body. Therefore, an artificial medical material, which can be described as large, is placed in a large vein of the patient leading to the heart. It is performed under local anesthesia under operating room conditions.
- Are there different types of catheters?
There are types of catheters popularly called temporary and permanent. However, for patients with impaired kidney function and in the last stage of need for dialysis, permanent catheters should be used, not temporary catheters. In fact, catheters, called temporary, are placed only for that period in patients who will need dialysis a few times and who will not undergo dialysis after being discharged from the hospital. Normally, it is called bedside catheter. It is worn in cases of poisoning that the kidneys will have difficulty in filtering, sudden heart failure, and increased fluid load in the body. It is removed after the patient's current condition improves and sent home, and there will be no need for further dialysis. Due to its material quality and form, this catheter is easy to dislodge, cause bleeding, or cause infection. It is very prone to rupture.
In reality, catheters are not desired to be permanent. Again, this is an incorrect naming. In fact, it is a catheter that can be used for a long time. It is produced from a different material and in a different form compared to the provisionally named catheter. Its production feature ensures that it causes fewer infections when present in the body and can be used for a longer period of time. Since catheters are materials that are connected to the outside and do not belong to the body, they negatively affect the quality of life in terms of foreign body reaction, infection, allergy, need for dressing and care, and difficulty in maintaining personal hygiene. The purpose of inserting catheters is to save time for patients who cannot wait until special structures called Fistula are created.
- What is Fistula?
Fistula medical It is called Arteriovenous Fistula-AVF. It is a special surgical procedure performed to connect the patient to a dialysis machine and provide the required pressure and amount of blood flow. A suitable vein is duly connected to an artery using special techniques. After the successful procedure, under ideal conditions, no procedure such as dialysis is performed in this area for at least 3 months. During this period, the vein, which normally has low pressure and has a thin vascular wall structure, becomes a special vein of its own, where there is higher pressure as it is connected to an artery, and the vascular wall structure thickens and strengthens according to this pressure and flow amount. By checking the vein in this structure, it is allowed to be used for dialysis. Catheters save time for this surgery and vascular replacement process.
- Is this always the way to go, a catheter is inserted, a fistula operation is performed, as if waiting?
This point is very important. In fact, the ideal thing is that the patient with renal failure should be referred to a cardiovascular surgeon for fistula surgery at least 4-6 months before undergoing dialysis. In this way, the procedure is performed when the patient's general condition is better, the vascular structures are more intact and undamaged, and the chance of success and patient comfort are higher.
- Is the procedure difficult to perform, are there any dangers or risks?
This is a subject that I cannot help but mention. Catheter procedure , fistula surgery has only been embraced by cardiovascular surgeons with special interests. Therefore, it is extremely important for our patients to research this issue thoroughly and consult an experienced specialist. Even a seemingly simple procedure such as inserting a catheter can lead to consequences such as lung collapse, bleeding, and placement of the catheter in the wrong vein, leading to the death of the patient. For these reasons, it is necessary to evaluate the patient before the procedure and check the vascular structures where the catheter will be placed with ultrasonography. Similar issues are also valid for the AVF operation. AVF operations should be performed on the arms as close to the hand as possible. Thus, the length of the vessel in which the patient will be dialyzed is increased and the possibility of switching to the other arm after problems such as occlusion of the fistula is reduced.
- Are there other vascular access methods for dialysis patients? The most ideal vascular access method is Which one?
I would like to state from the beginning that the most ideal dialysis access route is fistula. However, the decision is made according to the patient and his condition. Artificial vein placement surgeries can be performed on patients whose own veins cannot be used, and catheter placement procedures from different areas, which are not used very often, can be performed in cases where there is no other option.
As a result, dialysis patients' veins are their lifeways. Therefore, it is important for them to consult Cardiovascular Surgeons who are experienced, experts in this field, and who can solve the problems that may arise after the procedure.
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