Contact Us:
Renal Dialysis

Tel: 705-474-8600 ext. 3777
Fax: 705-474-6606

Debbie Thomas
Program Manager
Hours of Operation:
Monday to Saturday
7:00 am to 7:00 pm

Renal Dialysis

Overview

A new expanded unit provides primarily hemodialysis for up to ten patients at one time. A multidisciplinary Pre-Dialysis Clinic has been instituted to monitor patients with early renal disease and assist in prolonging the quality of life prior to dialysis.

Patients Served

Patients requiring Renal Replacement Therapy - hemodialysis.

Vascular Access

Creation of a Permanent Vascular Access

Definitions

Artery
Blood vessel that carries blood that is oxygen rich from the heart to all parts of the body
Vein
Blood vessel that returns blood to the heart to get rid of wastes and obtain oxygen
Fistula
The surgical joining of an artery and vein using the body’s blood vessel
Graft
A synthetic material used to create an artificial blood vessel that is joined to the natural blood vessels
Hemodialysis
A process where the blood is removed from the body, put through an artificial kidney to clean the blood and then return the cleaned blood to the body
Thrill
A “buzzing” or “tingling” sensation felt over the fistula or graft
Bruit
A “whooshing” sound heard in the fistula or graft
Clotting
When blood flow slows down, the blood cells can stick together forming a “clot” or plug

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What is a permanent vascular access?

  • In order to perform hemodialysis, blood must be removed from your body, carried to an artificial kidney where it will be cleaned and then returned to your body.
  • To get your blood to the artificial kidney, it is necessary to create a special blood vessel. This blood vessel is made by joining an artery to a vein and is called a Permanent Vascular Access. The most common spot for this blood vessel to be created is the arm.
  • If your surgeon is able to create this permanent access using your own blood vessels it is called a Fistula (Fist u la). A fistula requires time and exercise to develop and mature before it can be used.
  • If your surgeon cannot create a fistula he will insert an artificial blood vessel, called a Graft. A graft can be used once the incision has healed.

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How is the blood taken from my body and then returned to me?

  • Before starting your dialysis treatment, two needles are inserted into the vascular access.
  • One needle is for the removal of the blood that will go to the kidney for the blood to be cleaned, and the second needle is for the blood to be returned to you once it has been cleaned.

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Is one type of access better than the other?

There are advantages and disadvantages to both fistulas and grafts.

Fistula

Advantages
  • Because it is a natural vessel, there is less chance of infection
  • New vessels can develop as the fistula matures
  • It has a long life span
  • There is minimal swelling post surgery
  • There is less clotting
Disadvantages
  • It requires 6-8 weeks to develop and mature before it can be used
  • It requires exercise to develop

Graft

Advantages
  • It can be used in 2-3 weeks
  • It does not require any exercise to develop
Disadvantages
  • There is an increased risk of clotting and infection because the graft material is artificial
  • Because of this increased change of infection and clotting, grafts often do not last as long as fistulas
  • There is usually more swelling after surgery

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Where will the surgeon put my fistula or graft?

  • Your surgeon will most likely put your vascular access in the arm you do not normally use the most (i.e. your non-writing arm).
  • The most common spot the surgeon uses to create the fistula or graft is your arm, either the forearm or the upper arm).
  • It is important that you protect this arm before surgery.

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How can I protect the arm?

  • Do not allow any blood to be drawn from that arm.
  • Do not allow an intravenous to be started in that arm.
  • Do not allow your blood pressure to be taken using that arm.
  • Exercise your arm regularly (squeeze a rubber ball).

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How should I care for my fistula/graft after surgery?

  • Before you are discharged, you will need to go to the Renal unit and a Renal Nurse will check your bandage. If there is a lot of blood on the bandage the nurse will change it. You will be asked to check your bandage the next morning and if you can see bloody drainage, call the Renal unit and a nurse will tell you what to do.
  • The staples on your incision will need to be removed (usually around 7-10 days). Before you leave the hospital you will be given an appointment in the Renal Unit to have the staples removed.
  • Keeping your arm raised on a pillow will help reduce the swelling.
  • Taking pain medication after your surgery will make you more comfortable.
  • You need to check your fistula/graft to make sure there is a good blood flow. To check the blood flow, place the fingertips of your other hand lightly over the fistula/graft and feel for a buzzing sensation. This buzzing is called a “thrill”. If you have no buzzing it could mean your access is clotting (blood cells stick together and form a plug).
  • Note: You may not feel the thrill right after your surgery. A nurse will show you how to check for the thrill. If you do not feel the thrill, you should call the Renal Unit at 705-474-8600 ext. 3777. If the unit is closed you should go to the Emergency Department. Remember, early reporting of no thrill may allow for treatment that will save the access.
  • Wearing a medical alert bracelet will help ensure the safety of your fistula/graft.
  • You need to clean your access arm daily once the bandage is off. Use mild soap and water. This will help prevent infection.
  • Once the incision is headed, use cream on your arm to help prevent dryness.
  • If your vascular access is a lower arm fistula, you may be asked to do some exercises after the incision has healed. These exercises help to develop the fistula. A dialysis nurse will show you how to do these exercises and tell you when to start.

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When to Notify the Renal Unit Nurses

Notify the Renal Unit nurses if:

  • Your access arm becomes red, hot or swollen.
  • You notice drainage on the bandage or from the incision.
  • The incision is very painful.
  • Note: If the unit is closed, go to the Emergency Department.

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How can I protect my access arm after surgery?

  • Do not sleep on the side of the fistula or graft.
  • Never allow anyone except a renal unit nurse to draw blood from the access arm.
  • Never allow a blood pressure to be taken or an intravenous to be started on the access arm.
  • Do not hold you fistula/graft arm in one position for a long time.
  • Do not use tight fitting bandages or wear tight clothing on the fistula or graft arm.
  • Do not wear anything on your access arm that could cause damage to the fistula or graft (i.e. watches, medic alerts, bracelets).
  • Do not carry heavy objects on your fistula or graft arm (i.e. grocery bags, purse).
  • Do not pick or irritate scabs that may form at the needle entry point on the fistula or graft.
  • If you use sharp tools, saws, knives, or do a lot of outside work, the Physiotherapy department can make a guard for your arm to help protect your access. Cuts around your access can be very serious.
  • Do not shave over the fistula or graft site.

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What do I do after my dialysis treatment?

  • Before and after your dialysis treatment, the renal unit nurse will check to make sure that they can hear a “bruit” (a whoosing sound caused by fast moving blood) and feel for a “thrill”.
  • Bandages, gauze or a pressure dressing will be applied to the needle sites after your dialysis treatment is finished. You should be able to remove them in four (4) hours or the morning after your treatment.
  • If bruising develops in the fistula or graft arm (discoloured areas caused by bleeding under the skin) it may be caused from the needles during dialysis. You should watch to make sure that the arm does not get swollen.
  • If you see a gradual increase in swelling, call the renal unit for instructions. If the unit is closed, go to the Emergency Department. If your arm suddenly starts to swell call 911 and apply pressure.
  • Note: When applying pressure, be sure that you can still fell the “thrill”. Too much pressure can clot your fistula because the blood flow is cut off.

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It is recommended that patients consult with their physician for any other symptoms or concerns that may apply to their particular case.