How do I take care of my vascular access site?

 

Do not sleep on your access arm/leg.  Do not let anyone take a blood pressure over your current access site.  Do not let anyone draw blood from your access arm.  No lifting more than 10 pounds with your access arm for 3 weeks.

 

I am bleeding from the incision!

 

If your access bleeds through the dressing/bandage, hold direct pressure to the access.  If it does not stop bleeding or it becomes excessive, call 911 or report to the neared emergency department. 

 

I have swelling in the limb where my access has been placed.

 

It is normal to have some swelling to the access limb following surgery.  However, if the swelling becomes severe, you develop a cold hand/foot, or have extreme pain in your access limb, call (559) 475-0431, or report to your nearest emergency department.

 

Are there any precautions I should take after I had my surgery under general anesthesia or sedation?

 

Do not drive or operate heavy machinery for 24 hours.  Do not sign any legal documents for 24 hours after having sedation.

 

I have a fever!  What do I do?

 

If you develop a fever higher than 100 degrees Fahrenheit or notice an abnormal discharge or pus from the access site, call (559) 475-0431.

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What is the difference between a fistulas and a graft?

 

Both surgeries create the ability to receive hemodialysis.  Fistulas are the direct connection between one of the arteries to a vein.  A graft uses a tube for hemodialysis access.  The tube is connected to an artery on one end and a vein on the other.  

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What is a bruit (pronounced brew-ee)?

 

It is the sound that an open, working vascular access makes from the turbulent flow.  It means that the access is functioning.  It may have different characteristics which are clues to your health care providers that it is working great or it is working, but may need further evaluation.

 

What do you mean by “thrill”?

 

A thrill is the “buzzing” sensation you feel over the vascular access site when it is working well.  You can feel it best with the palm of your hand.  The turbulent flow in the access site creates the buzzing and is something that should be checked daily.

 

I have stitches.  How do I get them removed?  How do I take care of the wound?

 

If you have stitches or staples that need to be removed following surgery, you should see us back in the office in 1-3 weeks after your surgery to have them removed.  You can start washing around the sutures with an antibacterial soap in 3 days after the surgery.  Please do not soak or scrub the wound site while it is healing. 

 

I don’t see any stitches?  Do I need to worry about my incision opening up?

 

Your surgeon used stitches underneath the skin to close the wound.  They will dissolve and do not need to be removed.  To reinforce the sutures, skin glue or butterfly tapes may have been applied.  The glue will peel off in about 2 weeks.  The tapes will fall off in 1-2 weeks.  You can get the wound wet starting on the second day after surgery, but do not soak or scrub the wound site for 3 weeks.

 

When can I get the dialysis catheter removed now that I have the access placed?

 

You can have the catheter removed after the newly placed access site can be used by your dialysis center successfully 3 times.

 

What potential complications are there by creating the vascular access site in the upper or lower extremity?

 

-Numbness and/or coolness in the forearm, hand or fingers, or the calf, foot or toes.  This is usually mild and may resolve by itself.

 

-Pain and/or burning sensation

 

-Need for multiple surgeries of the fistula or graft to increase blood flow to the hand or foot.

 

-Bleeding, infection or injury to adjacent structures

 

-The surgery may make any previous neuropathy or carpal tunnel syndrome symptoms worse

 

-The fistula may not fully develop and require additional surgeries

 

-The fistula or graft may become clotted, requiring surgery, further evaluation with an ultrasound, another procedure to remove the clot, and/or temporary access with a temporary catheter

 

-Rarely, there can lose the use of the hand or foot temporarily or even more rarely, permanently.

-Possible loss of the limb (extremely rare)

 

 

When can I drive?

 

You can drive your automobile, as long as it has an automatic transmission, in a week after surgery.

 

How soon can I use the new hemodialysis access fistula or graft?

 

A graft can be used in 2-3 weeks from the time it has been placed.  The fistula needs time for the vein to get large enough to be able to be accessed by the dialysis team.  That may take 6-8 weeks.

 

What type of anesthesia is used for dialysis access surgeries?

 

For hemodialysis access surgeries, there are many choices.  It can be performed under local anesthesia, local anesthesia with some sedation, a regional block where the entire limb is anesthetized, or a general anesthetic where you go entirely to sleep.

 

For peritoneal dialysis, it can also be performed under local anesthesia with some sedation or general anesthesia.

 

What do I need to look for after having a peritoneal dialysis catheter placed?

 

Check for a fever higher than 100 degrees Fahrenheit.  Look for redness of the skin around the exit site of the tube.   Some bruising is not out of the ordinary and will resolve over time.  Cloudiness of the fluid that is drained from the abdomen may be a sign of peritonitis.   Pain after the surgery generally improves daily.  If the pain is worsening, please call (559) 475-0431. 

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How soon can I use the peritoneal dialysis catheter?

 

It can be used immediately, but in smaller amounts of fluid.  In general, we like to give the incisions 2-3 weeks time to heal before the full amount of dialysate fluid is used.

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Why is Dr. Lowe’s cheek swollen?

 

Dr. Lowe has a cyst of the parotid gland (a gland that produces saliva) that he has had since birth.  He is fine and it doesn't bother him. 

 

Is there any paperwork required for my first visit?

 

Click HERE to be directed to the New Patient Paperwork? 
 

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Do you have additional questions?  Please contact our office at 559.457.0431