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  • Artificial Graft Blockage Problems

    My mother had an artifical graft placed in her right arm for hemo-dialysis access in Oct 2010. She gets her dialysis done in-center 3x / week. Beginning in early April 2012, it became blocked and she was sent to a center to have it de-clotted. It blocked agian the next day, de-clotted again and a stint was inserted into the graft. The graft blocked again a week later, was de-clotted again and a 2nd stint was installed. Things worked fine from that point until early July 2012 when the graft blocked again. De-clotted again and after 2 treatements, it clotted again. De-clotted last week and used once, then clotted again. In early July, a tunnel catheter was inserted so at least she would have a good access to continue her hemodialysis.

    She's having it de-clotted again this week (6th time now). The physical and emotional drain on her is enormous and I, as the caregiver, am getting quite pissed off of these band-aid approaches. She will be seeing the vascular surgeon that installed her graft end of this month for some answers. I also seem to think that it is technique after needle removal from the graft - clamps Davita uses tend to casue the clotting more and the way the clamp is placed is dependent upon the technician working on her. We don't have this issue when I take her to another Davita clinic 30 miles away from her regular in-town Davita center.

    Questions are:
    1) is there a finite lifetime for reliable graft usage?
    2) is this a problem with the amount of pressure or the technician using the clamps after needle removal?
    3) what are other peoples experiences

    I look forward to your feedback,
    Signed,
    Frustrated and Pissed Off in SW Ohio

  • #2
    For what it's worth, my techs advised against using claps for just this reason. If your mom can, she should hold the gauze herself until the needle site clots.
    Fistula - March 2008
    Began Dialysis - August 2008
    Fistula Revision - Feb 2011

    Dialysis Patient Citizens, Patient Ambassador
    NW14 ESRD Network, Patient Advisory Committee Member
    CDC Infections Control Discussion Panel Member
    National Kidney Foundation Peer-to-Peer Mentor

    Blog: www.DevonTexas.com

    Comment


    • #3
      From US Davis Medical group....
      To Prevent Clotting of Your A-V Graft:
      a. Daily check the blood flow to your A-V graft by feeling for the "buzz." If the "buzz"
      cannot be felt, go to the ER and notify your doctor immediately.
      b. Do not wear tight clothing or jewelry on the graft arm.
      c. Do not carry items (child, box, purse strap) that press against your graft.
      d. Do not sleep with the graft arm above your head or under your pillow.
      e. Do not allow venipunctures or blood pressures to your graft arm.
      f. Do not lift things heavier than 25 lbs. with your graft arm.
      g. Avoid exposing the arm to extreme cold.
      h. The dialysis staff will rotate puncture sites each time you use your graft for
      dialysis to preserve the life of your graft. Leave your post-dialysis dressings in
      place for 8 to 10 hours. If there is break through bleeding, apply gentle
      pressure to the site with a clean gauze square till the bleeding stops, about five
      minutes. Then re-cover the site with a Band-Aid.
      i. The dialysis staff will be monitoring the pressure in your graft during dialysis. An
      unusual rise in the venous pressure may suggest your graft is trying to clot. The
      physician may have your graft evaluated with a fistulogram. This test takes
      pictures of your graft and lets your physician know if your graft may need repair
      to keep it functioning.
      What if my A-V graft clots?
      If the "buzz" cannot be felt in your graft, it may be clotted. When this happens, it is not
      dangerous, but needs attention. The surgeon will need to remove the clot and any scar
      tissue that may have formed where the vein and the graft connect. Go to the ER and notify
      your doctor immediately. Your graft may be saved, if the clot is caught early. After surgery,
      follow the same precautions outlined on the previous page in "What do I do after surgery?"
      Generally, you won't have to stay overnight in the hospital.
      What if my A-V graft becomes infected?
      If your graft site has yellow discharge, becomes hot, red, swollen, or tender, it may be
      infected. When this happens, you should notify your physician immediately. Your doctor
      may order cultures of your graft and blood. If there is an infection, you will be given
      antibiotics, and your graft may need to be surgically revised or replaced
      Fistula - March 2008
      Began Dialysis - August 2008
      Fistula Revision - Feb 2011

      Dialysis Patient Citizens, Patient Ambassador
      NW14 ESRD Network, Patient Advisory Committee Member
      CDC Infections Control Discussion Panel Member
      National Kidney Foundation Peer-to-Peer Mentor

      Blog: www.DevonTexas.com

      Comment


      • #4
        Originally posted by mlemley8 View Post
        My mother had an artifical graft placed in her right arm for hemo-dialysis access in Oct 2010. She gets her dialysis done in-center 3x / week. Beginning in early April 2012, it became blocked and she was sent to a center to have it de-clotted. It blocked agian the next day, de-clotted again and a stint was inserted into the graft. The graft blocked again a week later, was de-clotted again and a 2nd stint was installed. Things worked fine from that point until early July 2012 when the graft blocked again. De-clotted again and after 2 treatements, it clotted again. De-clotted last week and used once, then clotted again. In early July, a tunnel catheter was inserted so at least she would have a good access to continue her hemodialysis.

        She's having it de-clotted again this week (6th time now). The physical and emotional drain on her is enormous and I, as the caregiver, am getting quite pissed off of these band-aid approaches. She will be seeing the vascular surgeon that installed her graft end of this month for some answers. I also seem to think that it is technique after needle removal from the graft - clamps Davita uses tend to casue the clotting more and the way the clamp is placed is dependent upon the technician working on her. We don't have this issue when I take her to another Davita clinic 30 miles away from her regular in-town Davita center.

        Questions are:
        1) is there a finite lifetime for reliable graft usage?
        2) is this a problem with the amount of pressure or the technician using the clamps after needle removal?
        3) what are other peoples experiences

        I look forward to your feedback,
        Signed,
        Frustrated and Pissed Off in SW Ohio
        Hey there mlemley8
        1) YES. the longevity of grafts vs AVF (Arterial Venous Fistula) is extremely polar opposites. AVFs can last to up to the rest of patient's life. Grafts' shelf life in general is 5-7yrs optimal. BUT...I do have a patient that has had his graft for 11yrs and couting.
        2) Clamps can cause blockages defintely! Is it possible for your mom to hold her sites one at a time? That is the best way. Especially if she doesn't bleed profusely.
        3) I'm the Vascular Access Manager & Adequacy Manager for my clinic...my experience as the VAM in my clinic is that the surgeon might need to contacted and or a vein specialist maybe be needed to intervene. Also please ask the amount of heparin she's on. They might need to increase the dosage. And is your mom on any blood thinners as her home medication?

        Comment


        • #5
          Originally posted by mlemley8 View Post
          My mother had an artifical graft placed in her right arm for hemo-dialysis access in Oct 2010. She gets her dialysis done in-center 3x / week. Beginning in early April 2012, it became blocked and she was sent to a center to have it de-clotted. It blocked agian the next day, de-clotted again and a stint was inserted into the graft. The graft blocked again a week later, was de-clotted again and a 2nd stint was installed. Things worked fine from that point until early July 2012 when the graft blocked again. De-clotted again and after 2 treatements, it clotted again. De-clotted last week and used once, then clotted again. In early July, a tunnel catheter was inserted so at least she would have a good access to continue her hemodialysis.

          She's having it de-clotted again this week (6th time now). The physical and emotional drain on her is enormous and I, as the caregiver, am getting quite pissed off of these band-aid approaches. She will be seeing the vascular surgeon that installed her graft end of this month for some answers. I also seem to think that it is technique after needle removal from the graft - clamps Davita uses tend to casue the clotting more and the way the clamp is placed is dependent upon the technician working on her. We don't have this issue when I take her to another Davita clinic 30 miles away from her regular in-town Davita center.

          Questions are:
          1) is there a finite lifetime for reliable graft usage?
          2) is this a problem with the amount of pressure or the technician using the clamps after needle removal?
          3) what are other peoples experiences

          I look forward to your feedback,
          Signed,
          Frustrated and Pissed Off in SW Ohio
          mlemley8,

          I was always taught that you should absolutely not use the clamps to stop the bleeding after treatment. This put too much pressure on the fistula/graft. Also, I have seen at least 3 people in-center rushed to the hopsital because of the clamps falling off and them losing large amounts of blood. Most centers use these so that they can go about their business and do other things...ei take others off etc... I would never use these devices to stop bleeding. I know many are unable to hold their own sites such as the elderly etc. But there is no reason why a nurse or tech cannot hold the site to stop the bleeding. This is part of the job and you should not take shortcuts.
          Many people are washed out during the end of treatment ( again another issue that can be avoided) and they may fall asleep, or be unaware of their surroundings. I say stay away from the clamps. They also can put too much pressure on your site, which can cause issues such as clotting.

          ///M3Riddler
          ______________________________
          PD - 13 Years
          3 Transplants
          In-Center Hemo - 6 Months
          NxStage - Since April - 06
          Facebook: Dialysis Discussion Uncensored

          ________________________________

          Comment


          • #6
            Hey there bimmer (m3) you're absolutely right about the clamps. They cause too much pressure and are only supposed to be used as a last resort for a patient that is profusely bleeding. On the other side of clamp usage...clamps will be used if a patient is unable to hold their own sites. The most optimal scenario would be for a patient to hold their own sites. Its a way for the patient to be more involved with their dialysis treatment as whole. And yes you're also right about a staff member being able to hold a site for a patient. There are countless times I've had to do so. That's where team work in the unit has to come into play.

            mlemley8 - if they are using clamps, ask if they are using 2 at one time. That WILL cause stenosis and/or clotting of the access. It is ok to use 1 clamp AT A TIME. I get on my staff about that constantly...and yet they still sometimes don't want to listen to me and wonder why patients have started bleeding more.

            General knowledge - everyone please keep in mind that accesses will eventually need to be worked on. Just like a car's engine, regular maintenance is a must but there are plenty of things you can do to keep things running smooth.

            last thing...I LOVE THAT THE PATIENTS HERE HAVE SO MUCH KNOWLEDGE AND ARE WILLING TO SHARE TO ONE ANOTHER. I wish my patient's were as helpful to others as the ones here! Keep up the great support system everyone!

            Comment


            • #7
              I want to thank EVERYONE who contributed their response and thoughts, it is truly appreciated. My apologies for not replying back sooner than this but life as a dialysis patient caregiver is exhausting while trying to keep up the household and working a full time job.

              I thought ya'll might like an update:
              The graft issue I discussed in my mother's right forearm was finally declared as 'dead' or non-functional by the vascular surgeon who originally inserted the Gortex graft several months ago. (her current access is a tunnel cath and has been in place since mid-summer). It was decided to try again with a new Gortex graft in her left forearm. It failed within one week after insertion and was subsequently removed a week after that. So, we're back to square one. Her nephrology team (whom I personally don't 'trust' that much) has asked her to get a second opinion from another surgeon in another city. Of course, I agree with a 2nd opinion but I also value the opinion of the original vascular surgeon who worked on her because he has a good reputation and cares about his patients. My mother will be seeing the original surgeon this weekend and the 2nd opinion sometime in December. Her veins and arteries in her arms are so small I strongly suspect that there is nothing that can be positively accomplished, which leaves the legs and/or groin area for an access (are her veins/arteries any larger there, I wonder?). Of course, I'm concerned about her tunnel cath access because it is so prone to infection, but fortunately, she's been lucky with keeping the site aseptic and infection free so far. She's pretty much stuck with the clinic she is, and hence her nephrology team, simply due to the fact that it's the only 'game' in town - the next nearest DaVita clinic (or any other for that matter) is 30 miles away and transportation then becomes an issue, plus that clinic is owned by the same nephrology team that owns the clinic she is going to.

              That's Mom's update. Thanks again for your kind advice, thoughts and prayers. I'll try to update ya'll again when we have more information as to course(s) of action. ML in SW Ohio.

              Comment


              • #8
                Wow. i'm very concerned this is the very same road i'm going to be going down very soon. im currently on hemo 3x a week through a groin cath because i have tiny/no vien access. im seeing a vascular specialist this monday to see about a gortex craft of some sort. do you have any advice? anything would be helpful. thanks and i really hope things are going well with your Mom.

                Comment


                • #9
                  I have been on hemo about 2.5 yrs,recently had it declotted was told by a tech needed to be done every 6 months never told this before first visit to examine it because I asked about the size of my fistula and was having a li pain during treatment which went away if I adjusted my arm changed its position,or lifted it in air a minute.i decided maybe I will get it declotted once a yr.i had 3 sharp stabs afterward which did not continue.i do thick it got a ill smaller and they say I had a ill blockage did not need any stints or anything else my treatment going well hopefully my clearance which was already good is even better now no report yet also the first time anyone even mentioned I should go to the excess center was when I asked about the size of my access which I thought looked large because my arms are small i weigh 52.7kilo 5feet2. That is why I resisted going at first and the doctor trid to send me because I bought it up

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