Dialysis Vascular Access Malfunction

What is Dialysis Vascular Access Malfunction

A vascular access is an entrance to your blood vessels that can be used for dialysis. Dialysis is a treatment used for kidney failure. A health care provider can make a vascular access in many ways, such as by:

  • Joining an artery to a vein under your skin to make a bigger blood vessel called a fistula.
  • Joining an artery to a vein under your skin using a soft tube called a graft.
  • Placing a thin, flexible tube (catheter) in a large vein, usually in your neck, chest, or groin.

A vascular access can become blocked or stop working correctly (malfunction).

What can cause my vascular access to malfunction?

  • Infection. This is the most common cause of malfunction.
  • A blood clot inside a part of the fistula, graft, or catheter. A blood clot can completely or partially block the flow of blood.
  • A kink in the graft or catheter.
  • A collection of blood (hematomaor bruise) next to the graft or catheter that pushes against it, blocking the flow of blood.

What are signs and symptoms of vascular access malfunction?

Signs and symptoms of vascular access malfunction include:

  • A change in the vibration or pulse (thrill) of your fistula or graft.
  • The thrill of your fistula or graft being gone.
  • New or unusual swelling of the area around the access.
  • An unsuccessful puncture of your access by the dialysis team.
  • The flow of blood through the fistula, graft, or catheter being too slow for effective dialysis.
  • Bleeding that cannot be easily controlled when routine dialysis is completed and the needle is removed.
  • Signs of infection such as pain, swelling, redness, red streaks, numbness, and blood or pus coming from or around the access.

What happens if my vascular access malfunctions?

If your vascular access malfunctions, your health care provider may order blood work, cultures, or an X-ray test to find out what went wrong. The X-ray test involves the injection of a dye (contrast) into the vascular access. The contrast shows up on the X-ray and lets your health care provider see if there is a blockage in the vascular access.

Treatment varies depending on the cause of the malfunction:

  • If the vascular access is infected, your health care provider may prescribe antibiotic medicine to control the infection.
  • If a clot is found in the vascular access, you may need surgery to remove the clot. Blood thinning medicines may also be used.
  • If a blockage in the vascular access is due to some other cause, such as a kink in a graft, you will likely need surgery to unblock or replace the graft.
  • If there is a malfunction for any reason, your health care provider may remove and replace your access.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, use it as told by your health care provider.Do notstop using the antibiotic even if you start to feel better.

Activity

  • Do notlift heavy things with the arm that has the access.
  • Try not to bump or hurt the arm that has the access.

Lifestyle

  • Do notwear jewelry or tight clothing around the access.
  • Do notsleep by placing the access arm under your head or body.

General instructions

  • Wash your hands with soap and water before touching the area around the vascular access. If soap and water are not available, use hand sanitizer.
  • Keep all follow-up visits as told by your health care provider. This is very important. Any delay in follow-up could cause permanent dysfunction of the vascular access, which may be dangerous.
  • Do notmeasure your blood pressure on the arm that has the access.
  • Keep the access area clean and do notuse makeup, creams, lotions, or ointments on it.
  • Check your access area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Contact a health care provider if:

  • Swelling around the vascular access gets worse.
  • You develop new pain.

Get help right away if:

  • You have bleeding at the vascular access that cannot be easily controlled.
  • You have pain, numbness, an unusual pale skin color, or blue fingers or sores at the tips of your fingers in the hand on the side of your fistula.
  • You have chills.
  • You have a fever.
  • You have pus or other fluid (drainage) at the vascular access site.
  • You develop skin redness or red streaking on the skin around, above, or below the vascular access.
  • Your access is hot, swollen, red, and very painful.
  • You can suddenly see the cuff of your catheter used in the access.

Summary

  • A vascular access is an entrance to your blood vessels that can be used for dialysis.
  • Several things can cause your vascular access to malfunction.
  • Treatment varies depending on the cause of the malfunction.
  • Keep all follow-up visits as told by your health care provider. Any delay in follow-up could cause permanent dysfunction of the vascular access, which may be dangerous.
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