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.