Evaluation and Pre-operative Testing for Dialysis Access
When your kidneys are healthy, they clean your blood and make hormones that keep your bones strong and your blood healthy. When your kidneys fail, you need treatment to perform the work your kidneys used to do. There are two treatments for kidney failure: transplant and dialysis. If you do not have a kidney transplant, kidney dialysis is crucial to maintaining your quality of life.
Dialysis replaces kidney function by using special equipment to clean wastes from the blood. There are two forms of dialysis:
Hemodialysis circulates blood through a machine outside of the body to remove poisonous wastes and excess fluid, and to correct electrolytes such as potassium, sodium, phosphate and calcium. The machine then pumps the cleansed blood back into the body. This type of dialysis usually involves going to a dialysis center three times each week, but can sometimes be done at home.
Peritoneal Dialysis uses the lining inside the abdomen as a filter to purify the blood by flushing the abdominal cavity with a diluted dextrose (sugar) solution. The solution traps waste and is usually drained from the abdomen through a surgically placed tube called a catheter. This type of dialysis can be done during the day, with four fluid exchanges through the catheter, or overnight using a special cycler machine that flushes your system while you sleep. It is your personal choice which type of peritoneal dialysis you decide to do. Peritoneal dialysis is done at home and can even be done at work. People who have had abdominal surgery are not the best candidates for peritoneal dialysis because scar tissue may interfere with the effectiveness of treatment.
What type of dialysis you get depends on what you and your doctors and nurses feel is the best fit for your lifestyle and your medical condition. Keep in mind each type of dialysis has pros and cons. By learning as much as you can about both types, you will be able to make the best decision for yourself. If your needs change, you may be able switch to another type of dialysis if your doctors and nurses feel it is medically possible.
Hemodialysis cannot begin until doctors establish a vascular connection between your bloodstream and the dialysis machine. This process is called hemodialysis access. Surgeons create vascular access in the arm or leg for hemodialysis by placing arteriovenous (AV) fistulae, or surgically placed shunt, and grafts that connect arteries to veins. Sometimes it is necessary for surgeons to place a catheter in the chest if hemodialysis is needed urgently, or if arm or leg access is not ready to use at the time hemodialysis is needed.
Peritoneal dialysis cannot be started until the special peritoneal dialysis catheter is surgically placed in the abdomen.
A Proactive Approach
It can take up to six months of appointments and treatments to establish access, depending on what kind of dialysis you need, so it is important to be proactive with your medical care. Your kidney doctor or nurse will be following your kidney function closely and will make the referral to the surgeons for dialysis access at the appropriate time.
Healthcare Professionals You Will See
When we evaluate you for dialysis access surgery, you will meet with a dialysis access nurse coordinator and a transplant surgeon who does dialysis access surgery. Both have extensive experience with dialysis access and will be able to answer any of your questions.
Evaluation is an outpatient process. While many of the tests will be performed at the Transplant Institute, some can be done at a hospital or clinic closer to your home.
During the evaluation, you will undergo a number of medical tests such as:
- Noninvasive vein mapping with an ultrasound to help surgeons determine which veins can be used for your hemodialysis access
- Blood lab tests
The dialysis access nurse coordinator will give you a physical exam and review your medical history as well as any experience you may have had with dialysis access. It is important to let us know if you have had any surgery or procedures that involved putting lines in your neck or if you have a pacemaker. This information is important because it could potentially impact how your surgeons create access for your dialysis treatment.
After the Dialysis Access Evaluation: Scheduling and Preoperative Testing
Once you have decided with your dialysis access team what kind of dialysis access you will need, you will meet with your dialysis access nurse coordinator, who will schedule your surgery and the preoperative tests you will have prior to the surgery.
For preoperative testing you will meet with an anesthesiologist for a physical and a review of your medical history. You will also have some blood taken for testing and may get an EKG (a test that electrically checks your heart rhythm to look for abnormalities or evidence of past damage) or chest X-ray if needed.