Daily self-testing to keep your kidney tubes clear and free from obstruction

Our kidneys are responsible for removing excess water, electrolytes, and metabolic waste from the body, and when the kidneys fail, hemodialysis and peritoneal dialysis have to be utilized to replace the function of the kidneys.

Dr. Zhang Jianhua, Director of Cardiovascular Surgery at Dahlin Tzu Chi Hospital, pointed out that, in general, for dialysis machines to achieve sufficient dialysis function, they need at least 200 milliliters of blood flow per minute to be able to use them. Only the arteries in our body have the means to provide such a large amount of blood flow, but the arteries are usually deeper, making it more difficult to stick needles in them. To overcome this difficulty, vascular surgeons can create dialysis tubes.

"A dialysis fistula is where the artery is connected to the vein so that blood from the artery goes directly into the vein," says Dr. Chang. Dr. Chang said, "The vein is more superficial, and under the impact of arterial blood flow, the diameter of the vein will gradually expand, making it easier to stick a needle for hemodialysis.

The original arterial blood enters the microvessel and then flows into the vein. To allow arterial blood to flow directly into the vein, you can use "autologous blood vessels" or use "artificial blood vessels". Dr. Chang explains that "autologous dialysis tubes" are grafted together with their own arteries and veins, and "artificial blood vessels" are placed on both ends of the artificial blood vessels, one end of which is connected to the artery and the other end to the vein, and then the artificial blood vessels are placed underneath the skin, so that they can be used directly to stick needles into them in the future if they need to be dialyzed.

"The problem with autologous dialysis tubes is that after a few months, the vein diameter may not expand and mature, and there is no way to stick a needle in for dialysis." Dr. Zhang and Hua analyzed, "Artificial blood vessels do not need to wait until the vein expands and can be directly lanced for hemodialysis, but artificial blood vessels have higher chances of obstruction, infection, and other problems. The vascular surgeon will discuss with the patient in detail and comprehensively evaluate the patient's age, needs, blood vessels, health condition, etc. to choose the appropriate dialysis tube.

When the dialysis tube is blocked, hemodialysis treatment will be interrupted and the patient will need to receive emergency treatment. To ensure that the dialysis tubes are clear, it is important to have them checked regularly.

"We teach dialysis patients how to tell for themselves, for example, to always gently touch the dialysis tubes with their hands to make sure it's a vibration rather than a throbbing sensation," Dr. Chang explained. Dr. Chang explained, "The dialysis tubes are different from normal blood vessels, when touching them, there will be a 'vibration' feeling, as if there is an electric current passing through them, a tingling sensation. This is because the blood in the dialysis tubes goes from the high-pressure system to the low-pressure system, so it produces a tremor.

In addition, it is also recommended that patients buy a stethoscope and keep it at home to listen to the dialysis tubes every day, and Dr. Chang said that it sounds like "hoo-hoo! Dr. Zhang said it would sound like "Hoo! Hoo! Dr. Zhang said it sounds like the wind blowing.

Daily self-testing, touching and listening with a stethoscope, can detect the narrowing or blockage of the dialysis tubes early, so that you don't have to wait until the day of dialysis to find out that it affects the dialysis treatment and disrupts the pace of life.

In addition to self-testing, it is recommended to return to the clinic every three to six months for a vascular ultrasound. Dr. Chang reminded that sometimes it sounds and feels normal, but a more detailed vascular ultrasound can detect some problems early and treat them as soon as possible.

What about the blockage of the dialysis tube?

When the dialysis tubes are narrowed or blocked, it will be more difficult to stick the needle, and the blood flow is not smooth, the dialysis machine often shows warning signals, and it may not be easy to stop the bleeding after the needle is removed. If your arm is swollen and painful, you need to see a doctor right away.

When you suspect a condition in the dialysis tubes, you need to do a vascular ultrasound examination first. Dr. Zhang said, "The vascular ultrasound examination can measure the blood flow in the dialysis tubes, see if there are clots, and confirm the location and severity of the narrowing of the dialysis tubes, which will help the doctor to draw up a treatment plan.

In order to solve the problem of dialysis fistula, most of the current minimally invasive catheter interventions, Dr. Chang said, "We will carefully pass the catheter through the narrowing of the dialysis fistula, and then open the balloon catheter to dilate the diameter of the blood vessel, so that the blood flow can be smooth through.

In some special cases, a stent is placed to keep the vessel open. Dr. Chang explains, "Artificial vascular stents are more commonly used in dialysis tubes, and they are different from the stents used in cardiac catheters. Coronary arteries of the heart use a 'bare stent', which looks like a mesh metal stent; while dialysis tubes more often use a 'coated stent', which is not only a metal skeleton, but also wrapped with a layer of artificial vascular film. For dialysis patients, artificial blood vessel coated stent will be more effective than bare stent. The physician will decide whether to put in an artificial vascular coated stent to keep the dialysis tubes open, depending on the situation.

The care of dialysis tubes requires the cooperation of all three parties: the patient, the dialysis center, and the vascular surgeon! Dr. Chang explained, "In the past, when a patient had a problem with the dialysis tubes, the dialysis center would ask the patient to go to the surgeon for examination, and after the surgeon's examination, the patient would be asked to go back to the dialysis center. The surgeon and the dialysis center are often contacted through the patient, but the patient does not know what the warning message on the dialysis machine means, and is not clear about the condition of the dialysis tubes, and there is often an error in the transmission process.

In order to solve such a dilemma, Dahlin Tzu Chi Hospital has cooperated with about five dozen medical institutions and dialysis centers in Yunlin, Chiayi, Tainan, Changhua, and Nantou to ****together construct a dialysis tubes integrated care model. Dr. Chang said, "As long as a patient's dialysis tubes have a condition, the dialysis center can immediately contact the vascular surgeon, explain the patient's problem, and then help the patient make an appointment with the surgeon's clinic for further testing. If the dialysis tubes are already blocked, the surgeon will arrange for emergency treatment.

In addition to the immediate communication channel, there is also a case manager who is responsible for tracking the patient's condition. Dr. Zhang said that he has tracked nearly 1,000 patients. Because dialysis tubes need to be checked every three months, each dialysis center will be notified a week in advance and asked to remind the patient. If a patient does not return to the clinic, the case manager will continue to follow up and understand the reason, and ask the patient to have regular checkups as much as possible to ensure that the dialysis tubes are open. The case managers will also teach patients to take care of their dialysis tubes and provide them with some practical medical knowledge.

"We also hold regular seminars for physicians and nursing staff of dialysis centers," said Dr. Chang.

After dialysis, patients must always pay attention to keep their skin clean, do not wear bracelets, do not wear clothes that will tighten your arms, do not carry heavy bags, do not press your arms when you sleep, etc.

To keep your skin clean, do not wear bracelets, do not wear clothes that will tighten your arms, do not carry heavy bags, and do not press your arms when you sleep. If the dialysis tubes are properly taken care of, they can be used for more than ten or twenty years. Dr. Zhang Jianhua urges that regular tracking and close cooperation with physicians will enable dialysis patients to maintain normal work and have a good quality of life even if they undergo hemodialysis.