Question

formation of haemodialysis​

Answer 1

In haemodialysis, blood is removed from the body and filtered through a man-made membrane called a dialyzer, or artificial kidney, and then the filtered blood is returned to the body. To perform hemodialysis there needs to be an access created to get the blood from the body to the dialyzer and back to the body.

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Answer 2

What is haemodialysis?

Haemodialysis is a proven method of removing waste products and extra fluid, which build up in the blood when the kidneys are no longer able to function properly. To accomplish haemodialysis it is necessary to have easy access to the blood vessels. This is because treatment is required up to three times a week.

What is a catheter?

Access can be achieved temporarily by placing a catheter (artificial tube) in one of the large veins in the neck or in the groin to enable dialysis to be undertaken.

This method is not without problems, especially a tendency towards clotting (which renders the catheter ineffective) and the development of infection - requiring removal of the catheter and placement of a further catheter in another vein. There are patients for whom this form of access is their only “lifeline” and the catheters may, with careful handling, last months or even years. They are a little unsightly and restrictive, but most patients tolerate them well.

And what is a fistula?

An alternative and more permanent means of access to your circulation is by means of a fistula (Figures 1a and 1b). In general, flow through the superficial veins of the body is somewhat slow and low in volume yet, for dialysis, at least 200l of blood needs to be removed every minute for treatment. To achieve this a fistula is constructed. A fistula is an artificially formed link between an artery and a vein. As a vein is exposed to the higher pressure from the artery, the walls of the vein become thicken and more prominent and thus more capable of withstanding repeated puncture by needles.

How is a fistula created?

The fistula is usually placed at the wrist or inner part of the elbow depending on the size of the blood vessels in the non-dominant arm (i.e. left if you are right handed) so that when dialysis is undertaken you have the ability to perform other activities.

The construction of the fistula is undertaken in the operating theatre, usually under local anesthetic. However, there are occasions when you may require a general anaesthetic. After the fistula has been constructed it begins to mature. This usually takes between six to eight weeks depending on the initial size of the blood vessels. Even before the fistula becomes usable, the rush of blood through its new path can be felt. This sensation is called a ‘thrill’. It is a ripping or buzzing sensation that is felt when the soft pads of the fingers are placed over the skin. The fistula should be felt daily and if there is no thrill you should immediately contact the renal unit.