Hemodialysis and Vascular Access
Dr. Chun-Zhong Liu
Jen-Ai Hospital
Head of Nephrology Department,
Hemodialysis Room, Taichung Branch
Mrs. Yang requires routine hemodialysis due to her uremia, one of the diabetic complications. Difficulties in fistula injection were significantly increased because of both innate and acquired problems caused non-functional fistulas and infections. She avoids hemodialysis for the pain caused by the injection, and changes from one hemodialysis center to another. It was heartbreaking for Mr. Yang, a fishing enthusiast, to hear Mrs. Yang to cry out words like “I am sad when the attempts for the injection fail one after another. I wonder if this is how the fish feels with the hook is in its mouth when you go fishing.” Mr. Yang’s never went fishing afterwards.
The Yangs visited Jen-Ai Hospital through a friend’s recommendation. Mr. Yang told me frankly that he believed that all dialysis centers were the same; none of the dialysis nephrologist could do anything about the blood vessels. He is willing to give Jen-Ai a try because they heard that the nursing staffs here are more experienced and have better technique.
I examined Mrs. Yang’s blood vessels. The fistula on her left arm was clogged. It was marred with bruises and was swollen, inflamed, and covered with the needle scars. The fistula on her right arm was newly installed. I could feel the pulse but the blood flow was weak upon auscultation. Her condition was not encouraging and that worried me. Mrs. Yang had a double lumen catheter installed on the right side of her neck for temporary vascular access. She told me that she did not have sufficient blood flow during the hemodialysis (less than 200 cc/min). In addition, the blood pressure in her vein was high, triggering the alarm on the hemodialysis machine to go off whenever she moved, which led to termination of the hemodialysis. Even though she started the hemodialysis earlier than other patients, she was still struggling with procedures while others were already done with their procedure. She was especially uncomfortable about that.
In my opinion, problems with Mrs. Yang’s blood vessels had to be tackled first to improve the quality in dialysis. Not only the vessels should be taken care of, not just the swelling on the left forearm, the newly installed arteriovenous fistula on the right arm should be well maintained. We also needed to think of a way to increase blood flow to the double lumen catheter on her right neck, it would be best if the rate of 250 ~ 300 cc/min can be achieved, so that the clearance rate could be enhanced. For the location where the surgery was performed recently on the right wrist, I decided to use Firapy (WS™ Far-infrared Therapy Unit, a broad spectrum therapeutic device) for the treatment. I asked Mrs. Yang to concentrate on squeezing a ball with her right arm while applying hot compress on the catheter puncture site, and cleaning the site with Hirudoid™ cream.
The device was used every time she came for hemodialysis to irradiate her thighs for 40 minutes, to increase the blood flow of the large veins. The device was also used on her left forearm for 40 minutes, to aid the recovery process of the swollen, painful arm covered with a bad and non-healing puncture wounds to reduce swelling and to promote healing. Given the treatment regimen, the blood flow in both Mrs. Yang’s arms and the double lumen catheter on her right neck improved. Three weeks later, the task given to double lumen catheter was fulfilled with outstanding results and it was removed. In the subsequent dialysis, vascular access was no longer a nightmare for Mrs. Yang and the dialysis nurses. I was also more confident about the therapeutic effects of Firapy (WS™ Far-infrared Therapy Unit).
A couple of months later, Mr. and Mrs. Yang returned to their home in the countryside. Although we have good service and excellent skills in Jen-Ai Hospital, we cannot go home with them. They brought a Firapy (WS™ Far-infrared Therapy Unit) home with them. Mr. Yang was joyous and said, “Although the nephrologists could not grow new blood vessels, they know how to take care of them. They also taught us how to take good care of the blood vessels. It’s a praiseworthy achievement!” I couldn’t help smiling after hearing his comments.