For many patients, PD is the last resort after all 6 heomo access ( Top 4 + 2 Femoral) are deeply thermbosed. Do we have treatment to prevent venous getting choked ? Also, for CAPD what are the good practices of hygiene to ensure no infection, since this is the last option.
There are more than 6 places where you can have a HD access. In fact, this document has a picture that shows 10 sites where an HD access can be placed. It also answers a number of questions about HD accesses.
It’s important for the surgeon who is placing the HD access to do a test called vessel mapping prior to placing the HD access to make sure the vessels in that area are good enough for it to work well. Once an access is placed, there are tests to make sure blood is flowing through the access like it should or if there is a narrowing in a vessel that might cause blood to clot.
To prevent clots, patients are supposed to be taught to check their HD access daily to make sure they hear and feel strong buzzing. If the buzzing seems less, they should contact their dialysis clinic surgeon right away. The surgeon can stent an HD access that is narrowing and s/he may be able to remove a clot to save an access. Here’s a resource that may help you know more about vascular accesses and how to take care of one.
You asked about good hygiene and PD. When you are trained to do PD, your home training nurse should tell you how to prepare the area where you’re going to do PD to reduce the risk of germs getting into your PD catheter, including how often to dust and vacuum, where to store supplies, how to clean the area where you’ll place the supplies you’ll need to do an exchange or hook up to the cycler. The nurse will tell you to close windows and doors, turn off ceiling fans/air conditioner/heater, and how to mask yourself and keep animals and people who aren’t masked out of the room when you connect/disconnect. He/she will teach you what to use and how and how long to wash your hands and prepare your PD catheter and exit site before and after dialysis and much more. Here’s some basic info about PD.
Transplant is another option or kidney failure besides HD and PD. You can find out more about transplant by talking with a transplant program. This website has lots of info about transplant.
Thank you Beth for a very detailed answer. Is there a way I call you through skype to know more on CPAD issues ??
I’m a nephrology social worker and have some knowledge of PD. Your best resource for PD questions is our expert, Ana Figueiredo, RN, ENB 136, MSc, PhD who is Adjunct Professor, School of Nursing at the Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil. You can post your PD questions directly to her and she’ll answer them. You can find her section on https://forums.homedialysis.org/.
I know that the precautions are nice.
Precautions related to PD, PD catheter and exit site care are not just nice but can help a patient avoid peritonitis (which is not only painful, but can cause scarring of the peritoneal membrane requiring switch to HD), hospitalization, and even death.