This is Andy’s place, but today’s post is an effort to educate you on what dialysis is all about.
https://www.healthgrades.com/right-care/dialysis/av-fistula-surgery
I have a fistula surgically created in my upper right arm. (Full explanation in the link above.) An earlier one in the upper left arm failed. I was transported that day by ambulance to the Box Butte General Hospital emergency room, where the bleeding was brought into control.
After the bleeding had stopped and I was cleaned up a bit, I was transported by ambulance to Regional West Hospital in Scottsbluff, about 57 miles away. That second fistula currently serves my dialysis needs, though I’ve had two angioplasties on this fistula to open blockage that interfered with proper dialysis. None of these procedures caused me pain or had complications other people have experienced.
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https://en.wikipedia.org/wiki/Kidney_dialysis
The method I get dialysis by is hemodialysis. This is explained in excruciating detail in the link above. There is little pain involved most times, though painful cramps can occur. The nurse in charge of my session will either reduce the rate of dialysis or add saline solution into the line to relieve the cramping.
Low blood pressure can occur during dialysis – the process removes blood from your circulatory system after all! The nurse gives me a medication that stimulates blood pressure when it drops too low, a regular occurrence for me, but not all dialysis patients.
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In the Wikipedia article (link above), this comment read true to my experience:
A 1999 study concluded that “patients treated in for-profit dialysis facilities have higher mortality rates and are less likely to be placed on the waiting list for a renal transplant than are patients who are treated in not-for-profit facilities”, possibly because transplantation removes a constant stream of revenue from the facility.[42] The insurance industry has complained about kickbacks and problematic relationships between charities and providers.[43]
When I was diagnosed with end term kidney disease in January 2016 at University Hospital, Denver, Colorado, I was placed in a care center in Denver to build my strength and take therapy. I had dialysis in a for-profit dialysis unit (Davita).
After a month in the Denver care center, I felt I was ready to return to Nebraska and I tried to convince the person responsible at the care center that the same things I was getting in Denver were available in Alliance, my hometown, namely therapy and dialysis at Box Butte General Hospital and care at Highland Park Care Center, both short distances from where I live. The care center lady checked it out and there was space available for me at both the hospital and care center for my care.
There was a hang-up, however. Davita in Denver needed to send my dialysis records to the next place I’d get dialysis, but “There’s no dialysis center in Alliance.” There is one in Scottsbluff, however: a Davita facility! Yes, instead of allowing me to return to Alliance, they shipped me to Scottsbluff so Davita, a for-profit chain of dialysis centers, could continue to get Medicare dollars for my care!
After a month in Scottsbluff, I finally convinced them there was nothing else they could do to help me and I was released from the care center, Davita gave my records to the Box Butte General Hospital dialysis unit, and I’ve had better care there than at Davita ever since.
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https://en.wikipedia.org/wiki/Catheter
How is my blood accessed to process through the dialysis machine? A catheter that looks like the first illustration in the link above. Does it hurt? Not much if at all. Nurses are trained to do the job and The ones here are tops! I tell them that often because they are superior in every way to staff in other dialysis centers where I’ve been.
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Bleed-out explained in a Wikipedia article:
Exsanguination is death caused by loss of blood. Depending upon the health of the individual, people usually die from losing half to two-thirds of their blood; a loss of roughly one-third of the blood volume is considered very serious. Even a single deep cut can warrant suturing and hospitalization, especially if trauma, a vein or artery, or another comorbidity is involved. The word comes from the Latin ‘sanguis’, meaning blood.[1]
I guess that is obvious news: you lose too much blood, and you die. For that reason, care is taken after the two catheters used to remove and return blood from your body through the dialysis machine are removed after dialysis.
Applying pressure throughout the process of removing the needle in your fistula, the nurse applies a bandage, places folded gauze over the bandage, pulls the needle out, then applies a large piece of tape over the whole to further apply pressure. Before turning the job of applying pressure to the patient, one of two methods is used: finger pressure or large clamps. My fingers tire and/or cramp, so I go for the clamp method.
Voilà! Everything but the big clamp! Pressure is applied for 10 minutes to ensure there is a good seal on the two puncture wounds. I go for 15 minutes because it seems like my blood needs a bit longer to form the seal.
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So what can go wrong? Yes, bleed out! Occasionally, pressure applied over the bandages fails is the pressure isn’t applied over the right spot. Pressure is applied blind, after all, a good guess where to apply finger or clamp to prevent an otherwise open wound from bleeding. I guarantee that these small openings can pour out copious quantities of blood! Alarming? Not if you keep your head and apply pressure to the sloppy mess blood pouring out on your clothes makes. You locate the “bleeder”, apply pressure, and return to the dialysis center to get the wound cared for.
Several comments on Facebook and here prompted this excruciatingly long explanation of the dialysis process. The bleed-out happens and is taken care of in a short time before the patient leaves the hospital. Were it to happen after the patient is home or away from the hospital, a ride to the emergency room might be needed, but this is rare.
Prayers aren’t needed for the person having a bleed out after dialysis. There isn’t a period of convalescence. It is a serious business when it happens because it has to be dealt with promptly. Dialysis patients learn the procedure because one can die if there’s enough blood lost. The bleed-out usually takes little more than a few minutes to clean the fistula area, reapply bandages, and reapply pressure till all is well. Application of Coban for additional pressure is typical, too, though many times it is applied over the other bandages in the first place. I usually get the Cobaan wrap, but didn’t the recent day I bled out.
The worst possible situation is to have a bleed out while asleep, a sure death, though very rarely one that happens.
It is absolutely amazing what science can do
Very true! It hasn’t been that many decades ago that people with kidney disease just died. I believe the actress Jean Harlowe died of kidney disease, though her religion was part of why she didn’t get whatever treatment was available back in the 1930s. Dialysis became available in the 1940s.
I think you are right about Jean Harlow. It sounds like a painful way to die
I know from my own experience that it is frightening because fluid buildup in your lungs impairs your breathing to a point where you can’t function. Take one step, and you have to stop long enough to take a second one, that sort of thing!
I’m sorry. That sounds awful
It’s frightening to have breathing problems. You literally are drowning as fluid fills your lungs.
Thank you. I remember getting assessed for a Fistula but my First-Husband wanted to be tested first and he was a perfect match for Mt Transplant.
Where one is young enough, a transplant makes good sense. You were fortunate to have a live donor so soon!
Glad you are getting better care where you go now.
Yes, and I’m glad I experienced four other places so I know just how superior my regular place is!
Thank you Doug for explaining this. I’m glad you don’t have to travel far for treatment.
It seemed helpful because of the odd responses readers had to the not-so-terrible occasional bleed-out this past week.
That was well put, Doug. Even had Andy with a concerned expression. We are a pair, ain’t we. Cheers, mate.
More than you might know! There was a stabbing here this week, a rare occurrence since this is “shoot “em up” America!
Vigilantes today. Two women beat the crap out of an old man, who bled to death. They, believed he was a child molester. Tsk!
Gad! I worry about you being out and about.
I’m a smidge nervous myself, Doug. Tsk!
Cheers mate.
Vigilance is a good thing. The punk predators are a scary lot!
They start younger nowadays, Doug. Or is it just me getting older? Hehe!
They – young punks – definitely existed here, at least, as long as I know.
Varmints is not a strong enough word for them, but they are more than a nuisance.
We send prayers (and purrayers) for your continued good care.
Thanks!
It’s good that you can get great treatment locally!
Yes. Before the unit here was established, people had to go to Scottsbluff for dialysis, an hour away.
The for-profit problem in health care is a real risk to patients, no matter what the condition. I ran across that when I had cancer many years ago. I am glad that you were finally sent back to Alliance, and got much better care.
Thank you for all the links and education, Doug.
You’re welcome! I am very much opposed to for-profit health care, but I believe this is how one political party would have health care and many other governmental and non-profit things be taken.
Thanks for the education, Doug. I hope all this goes well with you.
It looks good for the future, T.W.
An amazing explanation. Many thanks,
I don’t want people to think this is a terrible thing that goes away. It is a process that gives people a future, a new normal that may be time consuming and a bit gruesome at times, but it beats any alternative!
Oh my Doug 😢 I am glad you have a good service Cat 🐱
Me too!
Thank you for this detailed explanation, Doug. I wish you many more years of safely and professionally administered procedure, while maintaining a positive attitude – to 120.
Thanks, Dolly!
My honor and pleasure, dear friend.
Lovely Andy, understanding everything as if. Dear Doug, not easy what you live, but you are brave and keep everything under control and calmnes.. Always everything be fine for you, dear, Blessing and Happiness to you both. Thank you, have a nice Friday, and enjoyable weekend, Love, nia
Thanks, nia! Without insurance, it would cost me over USD2700 a week for just dialysis, so I am spared the biggest problem many younger people without insurance face, financial ruin!
Adorable Andy picture! It’s very interesting to learn more about dialysis. I’m so glad you are able to get such excellent treatment near the place that you enjoy living.
Yes, it takes a lot of stress off me to know it’s available, it’s close, and it’s done by caring, competent people
Thank you for the explanation, Doug. I know several other friends who require dialysis, but they rarely talk about it, I think because they regard it as unpleasant or not something one shares in “polite company.” (They should know by now that I’m not at all polite, but anyway, I’m glad to know about the procedure.)
About Davita, it’s been interesting that the state of California has repeatedly tried to pass a law requiring all dialysis centers to have certified doctors or PAs on staff during clinic hours. It’s supported by the nurses’ union and the state physicians’ board, but both the voter referendum and the legislative bill have been defeated, in large part due to heavy political advertising claiming there will be a shortage of dialysis treatment in California if such a law were to pass. There’s a poignant one where a man in a hospital gown looks earnestly at the camera, saying he will die if he doesn’t get treatment from his local clinic. I roll my eyes when I see it, but it apparently has worked, as voters have turned down the referendum twice. The source of the funding for these commercials is, of course, Davita and other for-profit dialysis centers here. Any attempt to force them to meet higher standards for care causes them to throw fits, or money and lobbyists in the capitol. Reading your account makes me hope the medical board hasn’t given up! And however much I dislike my HMO, I am glad they have their own dialysis clinic for treating their patients. It is staffed by a supervising physician and a team of trained nurses.
That would be a basic necessity! While the nephrologist and his assistant aren’t at thee unit all the time, a NP, who used to be a RN who worked in the unit and is well informed on the sorts of issues and emergencies that occur is a short walk away in her office. They all make regular visits to review patients’ medical needs, to review test results, and help in other issues like signing off on handicap license plate applications. A dietician and counselor also visit on a regular schedule. When there is a medical emergency, they can call for additional medical personnel as needed, and thy arrive in no time. At Davita, two such episodes happened when I was there, and the staff had to call for an ambulance to get the patient to care. In my unit, we are already in the hospital.