why do fistulas clott

[JEM]

Hello everybody,
My name is Jim. I have had E.S.R.D since 8/4/09 and have been on in-center hemo ever since. Today is the lowest day since that first day back in '09. My newest fistula has clotted. And evrytime I ask why all I seem to get is "I DON'T KNOW." I didn't think I would ever grow to. hate 3 words this bad.
The first fistula I recieved clotted after 18 months of use. I had an A.V. Graft put in my left arm which after 24 days had clotted. In fact if the techs didn't connect the tubes up fast enough the connecting tube would clot. I continually asked about the clotting but was back seated by everyone from my tech all the way up to my nephroloist. I went to my personal physician and told him of the problem to which he replied I needed to be on blood thinners,so he sent me to a hemotologist, who did several tests. When I went back to get the results and hoped to get on some type of thinner his associate said he thought I needed more test. So I went straight to my nephrologist to ask to be placed on blood thinners, which he did.So I've been on coumadin for two months and I'm still clotting.
Can someone tell me if you have had this happen to you. I feel like it's just me and the clinic could care less.

[IHaveFaith]

Re: why do fistulas clott

Hello JEM,

I'm sorry that a full day passed and no one responded to your post, however, I'm sure somebody will come across it soon and offer some answers or ideas. Until then, I did run a search and found a link that you can read, which does talk about reasons that dialysis accesses might clot. If you don't get some additional responses from people on the forum here pretty soon, don't give up, just post to the thread again. Sometimes if the users don't know or haven't any experience with what you are asking, they may hesitate to post a response. I just want you to know that we do read what is posted and that we do genuinely care about everyone that has kidney issues and we will try to be as supportive as possible.

My best to you, Jim! I hope that your spirits are lifted very soon.

http://www.aakp.org/aakp-library/Access-clotting/

[jeffmoore]

Re: why do fistulas clott

Hello everybody,
My name is Jim. I have had E.S.R.D since 8/4/09 and have been on in-center hemo ever since. Today is the lowest day since that first day back in '09. My newest fistula has clotted. And evrytime I ask why all I seem to get is "I DON'T KNOW." I didn't think I would ever grow to. hate 3 words this bad.
The first fistula I recieved clotted after 18 months of use. I had an A.V. Graft put in my left arm which after 24 days had clotted. In fact if the techs didn't connect the tubes up fast enough the connecting tube would clot. I continually asked about the clotting but was back seated by everyone from my tech all the way up to my nephroloist. I went to my personal physician and told him of the problem to which he replied I needed to be on blood thinners,so he sent me to a hemotologist, who did several tests. When I went back to get the results and hoped to get on some type of thinner his associate said he thought I needed more test. So I went straight to my nephrologist to ask to be placed on blood thinners, which he did.So I've been on coumadin for two months and I'm still clotting.
Can someone tell me if you have had this happen to you. I feel like it's just me and the clinic could care less.

oh wow! you guys, i know about the clotting of a graft all too well, as this was a big part of my hemodialysis life for a decade. There is so much to share, when i was first diagnosed with ESRD, yeah that is right, Stage 5, there was no monitoring of stages of CKD with the creation of GFR and this was back in 1990. Now back to my graft issues, it was evident, that i couldn't have a fistula (which is the best access for hemo, because of its potential longevity of usage, compared to a graft, which has a higher risk of the development of an infection, clotting issues, even artery narrowing, in which i experienced several times during my ten year run on hemo. I had several angiograms, and angioplasties of such, stents put in place. After numerous grafts and repairs (4 grafts in all), my fourth graft began to fail, (which was in my left thigh), it burst in the shower at home, and you would have thought i had struck oil, the blood was so out of control, it was coming out like a waterfall, (this is something i share more deeper in my second book), well, to make a long story short, the paramedics were summoned, and as soon as they entered my upstairs bathroom, they had the nerve to joke about all the blood that they saw, saying things like this looks like a scene from friday the 13th. My advice to anyone, who is faced with dialysis for their continued survival, if you have very small veins, like myself, it is OK to get 2 grafts, but don't consider getting a third graft, because of the hemo usage, your small veins will become last friendly, and i am a setting example of that, because when i transition to PD, after my fourth graft failed, i had to have my EPO shots intravenous, of course, i hated that, because it was an advantage on hemo, it could be administered right through the tubing, and when it came to drawing my blood on PD, it would be the most difficult thing, there are times when it would take three tries to finally get the blood, because my veins are tricky, they tend to move, when a needle is in their presence, and they also have the nerve to also hide. And don't talk about IV, you can just hang that up, there was a time not to long ago, when i had a nurse try three times, (that is what is allowed), then another nurse tried, she even warmed my arm up, hoping she could get this IV, and when that didn't work, the anthesologist (i don't know if i spelled that correctly), had to finally get this IV, by then, i was so out done, and i said to myself, these small veins of mine, are not very co operative. So, what i am trying to say, is you small vein pts. be aware, something i even share in my second book. Think very seriously about choosing PD, over Hemo. I wasn't fortunate to have a choice of dialysis treatment, when i was first diagnosed, my neph only mentioned hemo, and for that matter, he didn't even mention that there was another form of dialysis treatment, i had to learn this from another fellow pts, who was only on hemo temporary, and this occur, about three years after i had started hemo. I am glad that they have given pending dialysis pts. a choice of treatments to choose, in the last decade and a half. and in closing, the creation of GFR, has truly been a blessing, to help those in the early stages of CKD, prolong the disease, and in some cases, reverse the progression of CKD.

[M3Riddler]

Re: why do fistulas clott

Hello everybody,
My name is Jim. I have had E.S.R.D since 8/4/09 and have been on in-center hemo ever since. Today is the lowest day since that first day back in '09. My newest fistula has clotted. And evrytime I ask why all I seem to get is "I DON'T KNOW." I didn't think I would ever grow to. hate 3 words this bad.
The first fistula I recieved clotted after 18 months of use. I had an A.V. Graft put in my left arm which after 24 days had clotted. In fact if the techs didn't connect the tubes up fast enough the connecting tube would clot. I continually asked about the clotting but was back seated by everyone from my tech all the way up to my nephroloist. I went to my personal physician and told him of the problem to which he replied I needed to be on blood thinners,so he sent me to a hemotologist, who did several tests. When I went back to get the results and hoped to get on some type of thinner his associate said he thought I needed more test. So I went straight to my nephrologist to ask to be placed on blood thinners, which he did.So I've been on coumadin for two months and I'm still clotting.
Can someone tell me if you have had this happen to you. I feel like it's just me and the clinic could care less.

Jim,

You are absolutely receiving the wrong answer. I have had a good bit of issues as well and there can be many reasons why a fistula/graft can clot as well as ways of prevention.

Reason:
1. High Hemoglobin Level
2. High Iron Level
3. Not enouph Heparin
4. Other Meds that can cause clotting
5. Small veins ( which I have)

Possible Treatments
1. Keep your hemoglobin at a lovwer level - the higher your hemoglobin, the thicker your blood is, thus making it easy for blood to clot.
2. Same reason with Iron. If you get IV Iron, this can also cause clotting.
3. Heparin has a half of of approx 4 hours. The dosing depends on treatment length as well as body size.
4. Other meds can cause clotting as well.
5. Small veins can make it easier for the blood to clot. This can be managed by being on a blood thinner daily such as coumadin. ( this is something I am on daily) They like to keep my InR between 1.5 and 2.0. Many docs do not like this idea because this can have its own affects. You just have to weigh them out.
6. Also, what you eat can have an effect on your bloods ability to clot. This includes vitamin A and vitamin K.

Have you had an InR drawn anytime? What is your hemoglobin level?

It sounds as if your nephrologist is not doing his job to look into the issues you are having. Techs are just that...they come and go like the wind and many are not educated enouph to even tel you how to spell their own name. They are there for a paycheck and thats it... ( This does not go for all techs as there are some good ones)

There are reasons for everything..its just a matter of digging into the issue to find results.

Do you know the size of the vein/artery they used for your fistula or graft? If not, I would talk with your nephrologst and tell him you want a copy of any fistulagram reports. I would even go as far back as when they created your fistula/graft to ask for those reports. The size should be listed in the reports. You can even call the radiology dept and request a copy of the reports and get them put on a cd/dvd for your own copies. These are your records.

Finally, Dont be afraid to get a second or even third opinion at a facility that is not related to the current. When it comes to fistulas and grafts...American Surgeons are last ranking in the world. Please view this article as well as the links and slides. You will be amazed.

American Surgeons are still last

I have been to 3 different facilities in 3 different states...amazingly each had their own opinion and they were totally different. They often want to do whats easiest for them instead of what is best for the patient. They all have their own comfort level and will only work within their own personal parameters they feel comfortable with. Otherwise they will say...." Your veins are too small" This is why its important to get the size of your veins and know what they are. Some surgeons will not touch a vein smallter than 3.5 or 4 millimeters while there are others that will work with them as small as 2 or 2.5 mm. Yes, the larger the vein/artery, the better success, but for those who do not have large veins, you this does not mean that they will fail if you work with the smaller veins. You just need to find a surgeon that is comfortable working with them.

Feel free to message me if you would like additional information. I have a lot of articles I can share...

Be your own best advocate..Do not take no for an answer...If they are untiling to give you an acceptable answer, then perhaps its time to go to someone who will......
Hope this helps....

[cicero]

Re: why do fistulas clott

Jim, I'm sorry for the late response but I've been away for awhile.
Another thing that may contribute to the clotting is the speed of withdrawal. Are you on days or noghts, 4 hrs or 8 hrs. If you are on days consider nocturnal, NxStage, or D if qualified for any of these. PD avoids the problem and both NxStage and Nocturnal operate at lower speeds of flow. This does NOT mean that you won't have a AV failure because I did but it was over 5 years that it happened and 4 of the 5 years was on days, 4 hr, cycles.
Get a different Vascular Surgeons opinion. See what he/she has to say. Be especially alert since this is your renal artery. With out this we are dead.
Be alert and well informed.
Best regards
Cicero

[Dreveline]

I am a first timer on here so here is our situation.My husband was waiting for the fistula to heal before starting dialysis when it starting bleeding and puss running out and all over him and the bed during the night. They went in and cleaned out the clot but only to have the clot reform with an infection that almost took his arm. The doctor went back to surgery to take the fistula out when he discovered another clot and an infection spread throughout his arm. He came to ask me for permission to take a vein out of his leg to replace the vein that was destroyed in order to save his arm. Now we are waiting for him to heal again and not sure if they will place a fistula in another place. We were told blood clot just happen and they don't know why too. Where do we go from here?

[Loganwon]

I am a first timer on here so here is our situation.My husband was waiting for the fistula to heal before starting dialysis when it starting bleeding and puss running out and all over him and the bed during the night. They went in and cleaned out the clot but only to have the clot reform with an infection that almost took his arm. The doctor went back to surgery to take the fistula out when he discovered another clot and an infection spread throughout his arm. He came to ask me for permission to take a vein out of his leg to replace the vein that was destroyed in order to save his arm. Now we are waiting for him to heal again and not sure if they will place a fistula in another place. We were told blood clot just happen and they don't know why too. Where do we go from here?

Ask for a perm cath in your chest/neck. They can be used for up to a year and no one sticks needled into you. I did hemo for months using a perm cath. They run one end down the artery to your heart and the other one up to a vein in your neck. The surgery takes about 35 minutes and is done on an outpatient basis. Clots also happen from not drinking enough water. Yes they want you to limit your fluid intake, but having your blood too thick is the result of being dehydrated. Good luck in the future.