Manipal Hospitals (MHEPL)’s Post

Transcript

Namaskar, I am doctor Tirthankar Mahanti. I am a nephrologist in Manipal Hospital, Ghaziabad. Today I will be telling you about dialysis vascular axises. So this video will be useful for useful for you in three circumstances. If you are nearing stage five CKD and your regular nephrologist has advised you to get a vascular access created. Second scenario would be if you have already started dialysis and unfortunately you did not have a if you face the law or any other vascular access created and you started your dialysis through temporary dialysis catheter and now you are. Considering about long term vascular access, third scenario would be if for some reason your regular vascular access that is the fistula or epigraph. Is being given some rest, either because the overlying skin is infected or it has undergone some procedure, etcetera and for a short period of time you need an alternate vascular access. Aren't you know kidneys are blood filters and if they no longer can filter your blood enough then you need an alternate. You may need an alternate replacement for that and usually that is in the form of a dialysis machine. Dialysis machine is a machine filters which takes blood from you, purifies it and return it to you. So in order to take blood from you and return it. It needs to have an access to your blood pipes. So this access is called dialysis vascular access. It is usually of four types. The first and foremost is called arteriovenous fistula in salt AVF. The second one is something called arteriovenous graft or avichi. The 3rd and 4th one are two different types of central venous catheters, that is dialysis catheters. Dialysis catheters are basically manager made synthetic pipes which are inserted into your large blood pipe. And. The temporary catheter is a relatively sort of one, while the tunnel catheter is a relatively longer one with a cuff around it. The calf hutches specific purpose to serve what it does it it incites a tissue reaction that is the tissue beneath your skin that links to it and form scar tissue around it. So that tends to eliminate the space around the catheter. The bacteria, the bug can enter the bloodstream through the dialysis catheter. That is one of the side effects. That is one of the commonest side effect of having a dialysis catheter and that is one of the reason why it is not the preferred. Vascular option if a person is on long term hemodialysis. The back the bug can enter through 2 routes, one through the lumen of the catheter, that is through the hall of the catheter or around the catheter. From the skin, the bug can enter into the blood tribe around the catheter. And as I have told you before, the calf tends to eliminate obliterate the space around the catheter. So one route of spread of bug to the blood pipe is eliminated. So tunnel catheter or cuffed catheter tends to minimize the risk of infection, but it does not totally. Eliminated. So if you require dialysis for a very brief period of time, maybe for 2/3. Weeks, then a temporary dialysis catheter will do. But if you need dialysis for a prolonged period of time, then you have to consider doing one of the three vascular accesses, that is epistula, Eva, grant or tunnel dialysis catheter. If you physicalize created by attaching a vein to an artery. Aren't you might be remembering from your biology classes, there are two types of blood pipes. One is called artery which carries blood from the heart to the organs and it is thick walled and blood flow inside it is very high. While the veins are thin walled, they take blood from the organs back to the heart and the blood flow there is very sluggish. So when is vein is attached to an artery, the blood flow inside increases. On the wall gets progressively thickened, it becomes easier for your dialysis technician or nerds to insert a needle into the dilated vein and. Return the purified blood there through another needle. Every fistulas takes some time to mature, that is, they take some time for the blood flow inside them to increase to the maximum and the wall to get thickened. Usually the blood flow becomes maximum by two weeks of Grayson, while the wall thickening takes a slower pace, but by six weeks most of the epistula are usable. If your veins are not good enough, that is their tortures or very diminutive, then instead of the brain it synthetic pipe can be used and attached to the artery on the other end that pipe is attached to the vein. So from the artery the blood passes through the synthetic pipe into the vent and when you need to undergo dialysis, the synthetic pipe is poked and blood is taken from there and blood is returned there. So this is. The option for someone who does not have a good vein but has a decent artery. Though it looks like an attractive option, for some people it may be very vexing or costly affair because it takes a lot of effort to maintain an maintain every graph. Because the vein distal to the synthetic pipe tends to become narrowed and the avcraft tends to clot frequently, so multiple procedures are needed to keep them running. So in an Indian setting for money is a serious concern, it may not be an option for some people. Besides, the expertise to create an epigraph and to maintain an epigraph may not be as widespread as that is for tunneled catheter or fistula. So if is the ideal vascular axis, every fistula is the ideal vascular axis because of three regions. 1. It touch good longevity, that is, if it matches without any problems then it is likely to last longer. Second, the risk of infection is minimal. Third, it may be cheaper than the race 2. If it is not possible, then every craft is another option. If that is also not possible or that is not feasible in your specific circumstances, then the third option remains that is the tunnel catheter. And as I have explained, you explained to you before that tunnel catheter hub less risk of infection as compared to a temporary catheter. But catheter means there will remain a little bit risk of infection. But depending on your special circumstances, it may last for many years. And keep you adequate dialysis. So before and another advantage of dialysis catheter is that it is immediately usable. There is no time for maturation, so immediately after it is inserted it can be used. So before I end, I would like to impress upon one part. That the number of vascular accesses that can be created each limited. For example every fistulas can be created at 4 sites, that is on either at either wrist or at the elbows. Similarly, normally the catheters can be inserted at 4 sites on either side of neck or or or either groin. So altogether there are 8 common sites where vascular access can be created. So while one particular access isn't created, thoughts would be spent on maintaining the rest of the vessels so that you will have an option if the first vascular access fails. So while vascular access is being created, there should be mindful effort to preserve rest of the veins and there should not be any unnecessary poking of the veins. The veins have to be preserved. So if a doctor tells, if your doctor tells you that he is planning a vascular access in that in one particular limb, then the vessels in that limb should not be prepared for any region for Ivy canalize insert cell or for blood sampling. Thank you.