It seems easy enough. A patient needs dialysis. There is no permanent access placed. A dialysis catheter is placed. The patient goes home and receives dialysis as an out patient. At some point the patient gets a fever. Maybe antibiotics are given in dialysis. Regardless, the fever gets worse and the patient is taken to the emergency room where the patient is found to be septic. While this is often treated with antibiotics and the patient recovers, sepsis can lead to multisystem organ failure or death. This scenario happens all too frequently.
Catheters are commonly used in dialysis patients to bridge them to long term dialysis access. Ideally, a patient with chronic renal insufficiency should never have a dialysis catheter. These patients should be evaluated when their GFR (glomerular filtration rate) is about 25 by vascular surgeon. A vascular surgeon will determine if the patient will need access using a patient’s own vein or if some kind of alternative conduit is needed. By placing a venous access prior to a patient needing dialysis allows the access to mature so that by time dialysis is needed there is no reason to place a catheter. Artificial conduits are placed approximately a month before being needed. Patients should know their GFR and tell their doctors of any changes. Patients should make sure they see a vascular surgeon when their GFR is about 25 and keep their appointments.
Patients should prevent anyone from using their designated access site for blood pressure measurements or blood draws prior to and after access placement. This will ensure the vein is as healthy as possible and will be adequate for access. After access placement patients should avoid any tight clothing or bandages around the access site to prevent thrombosis. Most patients are able to feel a thrill in the access. This is akin to a cat purring. If a patient notices the thrill is no longer present he or she should contact a physician immediately to attempt salvage of the access site.