Category : vein mapping

Inside the OR

In : Nx Stage, short daily hemo dialysis, Uncategorized, vein mapping, Posted by on Mar.03, 2011

March 8, 2011

I’ve posted many articles about going to the Arizona Kidney Disease & Hypertension Center for what we call a tune up or a repair on the graft. We had an unexpected trip to the surgery center this last week, just 3 weeks after the last one. It is commonly done about every 3 or 4 months to keep the access in good working order. However, stenosis, or narrowing, of the graft can occur at any time. There are warning signs such as difficult cannulation or excess bleeding. We had difficulty over the weekend so showed up on their doorstep at 6:45 a.m. Monday morning, candy and treats in hand, and waited our turn. As always, the staff was gracious, lively and to task.

The first few photos were taken by me (Dawn loves her candy!) and the rest were taken by an operating room nurse so we could use them in our blog. She did a great job and shot the procedure from beginning to end . . .  scrubbing and sterilizing, anesthetic, inserting fiber optics into the graft and taking X-rays to find the narrowing. The last photo is the venogram unit taking X-rays to see if the balloon (venoplasty) was successful opening the graft. The graft is made of gortex and is about the diameter of a pencil. Gortex does not heal itself, but the body does the best it can to heal itself over the punctures from the dialysis needles used every day. It is truly amazing how the body defends itself as the needles are about the size of a fork tine. As time goes on, they may need to do a stent or even a new graft. One day at a time!

Click on photos to make them bigger.

How to eat an Elephant

In : dialysis, fistula, home dialysis, Nx Stage, short daily hemo dialysis, Uncategorized, vein mapping, Posted by on Jun.06, 2010

June 17, 2010

My absence from posting on the blog was due to several things. Lots of things were happening. Also I had gout in both knees and both wrists . . . . a revisitation from an attack 6 years ago. It goes on for 6-8 weeks and is very painful. While caregivers are not immune from health issues, they do creep up on you when you least expect. I am very good at pushing them into the background and working through whatever it is. I’m not bragging . . . I’m telling you how dumb it is. Attention all caregivers: pay attention to your own health and needs. If you are not well, you can’t take care of others. I’ll continue with our adventures and catching up with our story. As the old adage goes: How do you eat an elephant? One bite at a time.

John’s KT/V (his blood clearance after dialysis) has been diminishing slightly every month. We know this because once a month I draw blood before and after a treatment. The labs shows a “trend” of diminishing results. Dr. Rai has discussed this with us several months in a row at clinic visits. Before we add a day (from 5 x a week to 6 x a week), or add time to each day, there were some other things we were asked to try. One was to have the blood flow checked in the graft by going in for a tuneup. John had not had one since February, so we did that on May 28. While it takes time and it is surgery with anesthetic, it is pretty painless. And the crew at the AKHDC is always ready to laugh and giggle, as you can see in the photos, and they love a new supply of candy and goodies. There was a 60% to 70% narrowing in the venous anastamosis (top of the graft) so an angioplasty was done.

The other possible solutions were to swap out our dialysis machine and the control panel on the machine that makes the therapy fluid for new ones. While this is not hard, again it just takes time, a little planning, some programming of the new machines and a little muscle. There were lots of calls to the Nx Stage technicians to get everything working properly . . . . some times very late at night. The technicians can talk you through just about anything and are always very polite and good humored. There is no fear in calling them any time of the day or night. If you need something fast, they’ll have it on your door step the next day. We are grateful to these people for making this just a bit easier for us. Without exception, they have been knowlegable and well trained.

We were also asked to go in for vein mapping to see if there was a possibility for another fistula. The year before dialysis began, John had 2 failed fistulas and two surgeries to try to enhance them. These also failed. It takes 4-6 months for the vein to mature and be used as an access. We did not think of it as an option at this point, but Dr. Rai encouraged us to try this again. Modern medicine makes huge strides in 4 years! On June 20 we went to the AKHDC office and Bette (who also works in the surgery center and knows us well . . . can you tell?) did the ultrasound. She found a vein in the left arm that looks good enough to turn into a fistula. It is deep so will have to be brought up, but they can do this in one procedure. We are waiting to be scheduled. Now that the graft is showing signs of wear, it is very important that we get on with this as it will be months before it matures. Like I said, eat the elephant one bite at a time.

The post has gotten very long, but in catching up somewhat, I can just go forward from here. I have a new iPad and can blog anywhere in the world now! This is really important as we are waiting for our 6th grandchild to come into the world. I will be on my way to Washington state as soon as I know he is on his way and stay for 4 or 5 days. I am hoping John is in a good place. On a wing and a prayer!