Name of the Procedure:

Maintenance Hemodialysis without Catheter Medical Terms: Maintenance hemodialysis, vascular access hemodialysis, long-term hemodialysis

Summary

Maintenance hemodialysis is a treatment for patients with end-stage renal disease (ESRD) who require ongoing dialysis to filter waste and excess fluids from their blood. This particular procedure is for those who have been undergoing hemodialysis for 90 days or more and use a vascular access method other than a catheter, such as an arteriovenous (AV) fistula or graft.

Purpose

Medical Conditions: Chronic kidney disease, end-stage renal disease. Goals: The procedure aims to maintain adequate blood filtration, manage fluid balance, and remove toxins, ensuring stable health while waiting for a kidney transplant or as a long-term treatment.

Indications

Symptoms or Conditions: Severe kidney function impairment, symptoms of uremia, fluid overload, electrolyte imbalances. Patient Criteria: Patients with ESRD undergoing hemodialysis for 90 days or more, utilizing a vascular access method other than a catheter.

Preparation

Pre-procedure Instructions: No specific fasting required; maintain regular medication schedules unless advised otherwise by the healthcare provider. Diagnostic Tests: Blood tests to monitor kidney function, electrolytes, and complete blood count (CBC).

Procedure Description

1. Access Site: The nurse or technician will clean and prepare the AV fistula or graft site.
2. Needle Insertion: Two needles are inserted—one to draw blood from the body into the dialyzer (artificial kidney) and one to return the filtered blood.
3. Blood Filtration: Blood is circulated through the dialyzer, where it is cleaned and returned to the body.
4. Monitoring: Vital signs and dialysis machine parameters are monitored throughout the session.
5. Completion: Needles are removed, and the access site is bandaged.

Tools: Dialysis machine, dialyzer, hemodialysis needles, tubing, antiseptics. Anesthesia: Not typically required; local anesthetic cream may be used at the needle site.

Duration

Approximately 3 to 5 hours per session, typically performed three times per week.

Setting

Performed in a dialysis center, outpatient clinic, or sometimes at home with appropriate training and equipment.

Personnel

Healthcare Professionals Involved: Dialysis nurse or technician, nephrologist, occasionally a dietitian, and social worker.

Risks and Complications

Common Risks: Low blood pressure, muscle cramps, itching. Rare Risks: Infection at the access site, blood clots, bleeding, or an allergic reaction to dialysis equipment.

Benefits

Expected Benefits: Effective removal of waste products and excess fluids, improved electrolyte balance, better management of chronic kidney disease symptoms. Onset of Benefits: Generally immediate after each session, with ongoing improvement over time.

Recovery

Post-procedure Care: Monitor for any signs of infection or issues at the access site, stay hydrated, and follow dietary recommendations. Recovery Time: Typically, there is no significant recovery time needed post-session; patients can usually resume normal activities shortly after.

Alternatives

Other Treatments: Peritoneal dialysis, kidney transplant, conservative management with medications. Pros and Cons: Peritoneal dialysis allows more mobility but is less effective for some patients. Kidney transplant offers a more permanent solution but involves surgical risks and waiting time. Conservative management does not involve dialysis but may result in worsening kidney function over time.

Patient Experience

During the Procedure: Patients may feel a prick when needles are inserted, and some discomfort from sitting or lying still for several hours. After the Procedure: Patients might feel tired but can usually resume regular activities. Pain management, if needed, typically includes over-the-counter pain relievers or prescribed medication.