Preventing complications
Hygiene measures prevent infections and complications and are therefore of great importance in everyday life.
It is also very important to take your medications as prescribed, even when you are feeling well to avoid complications, and to report any side effects to your physician.
Body hygiene
The skin is the body's natural barrier against microorganisms. This natural barrier is injured when puncturing an arteriovenous fistula or arteriovenous graft. In patients with catheters (either in peritoneal dialysis or hemodialysis), the skin is injured during insertion and there is also a risk later due to improper handling during connecting/disconnecting. Therefore, great importance is dedicated to hygienic / aseptic working practices in home dialysis training.
Asepsic refers to all measures to reduce the number of infectious microorganisms.
Hand washing and disinfection
Hand hygiene aims to reduce the number of infectious agents in order to significantly minimize the risk of infection. There are two techniques for hand hygiene: Hand washing (with soap and water) and hand rubbing (with alcohol-based formulation). Perform one of them always before taking any action related to your treatment, especially:
- Before preparing for treatment
- Before setting up the dialysis machine
- Before puncture
Vaccinations and avoiding infections
Patients with chronic kidney disease have a higher risk of infections due to their compromised immune system.
Vaccinations can protect you from getting a severe infectious disease by enhancing your body's immune system response by inducing the production of specific antibodies. They are necessary because they help your body find and kill the specific organisms if you encounter the actual disease. Vaccinations are normally completed with just one shot: some require additional shots or repetitions from time to time to produce a sufficient immune response. Vaccinations mean that the risk of people falling ill, and infecting others can be reduced significantly.
Several vaccines are recommended for the general population, with some additional recommendations for patients with chronic kidney disease. Vaccinations for influenza, pneumococcus, hepatitis B and tetanus / diphtheria are especially important.
Your care team will support you in getting your vaccinations and remind you about them if you would like. If possible, please bring your vaccination passport with you when you visit your physician, as you might also receive vaccinations from different physicians.
How to prevent complications associated with hemodialysis
As the most important member of your health-care team, you play the key role when it comes to preventing or correcting problems that can lead to long-term and even life-threatening complications.
You can help prevent complications by:
- Taking steps to prevent infection, such as practicing good hygiene at your vascular access site and disinfecting your hemodialysis machine system as advised
- Routinely evaluating the status of your vascular access for signs of infections or any other problems
- Being diligent about your dialysis. Skipping dialysis or not doing it according to your prescription may lead to complications
- Keep in touch with your physician and nurse! Show up at appointments and call in case of question or complication
There are three kinds of vascular access for hemodialysis:
- Arterio-venous fistulae,
- Arterio-venous grafts, and
- Central venous catheters (CVCs)
An AV fistula is usually first created by a surgical procedure in the non-dominant. The connection betweentheartery and thevein ensures that a higher blood flow in the vein is obtained. Due to this, the vein expands, making regular cannulation easier. This is the preferred access for hemodialysis, due to a lower complication rate and better clinical results. The fistula usually takes six to eight weeks to mature before it is ready for cannulation.
If there is any difficulty in creating an AV fistula, an artificial AV graft can be an alternative. This requires connecting the artery and the vein by a synthetic tube implanted under the skin in the arm. In comparison to the AV fistula, it can be already cannulated after two to three weeks; however, complications from blood clotting or infections may occur more often. Nevertheless, grafts can last for several years if they are well looked after.
A CVC is a silicone tube placed into a large blood vessel, usually the jugular vein at the bottom of the neck. This invasive procedure is normally carried out under local anesthesia by a nephrologist. The CVC can be used on a temporary or permanent basis.
Unsuccessful cannulation with AV fistulae and grafts
After an unsuccessful cannulation, a hematoma may appear. A hematoma is a localized collection of blood, usually clotted, in the tissue. Blood may seep into the surrounding tissue, e.g., after an unsuccessful needle placement. If possible, do not place the needle in this area and give the area several days rest until the problem resolves. Do not forget to inform your unit if you are being treated at home!
If your fistula or graft is red, swollen, and/or painful:
- Do not puncture it!
- Inform your dialysis team immediately!
- Keep your arm elevated!
- Cool your arm, e.g., with a cooling compress (make sure that frostbite does not occur).
Any further questions regarding your preparation for dialysis?
