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dialysis access

Self-cannulation

Bill Peckham, the author of the excellent patient advocacy and home dialysis blog: dialysis from the sharp end of the needle has been on dialysis since 1990 and home dialysis since 2001 where self-cannulates using the buttonhole method….

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Bury it!

One of the issues that we come across repeatedly in the clinic is the timing of access insertion. We all want to avoid the use of catheters and so we refer patients early (when possible) for fistula formation….

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Femoral versus Jugular: part three

Previous posts have discussed various iterations of the cathedia study, a study comparing femoral and jugular placement of dialysis catheters in patients in the ICU. As mentioned before, the femoral route was not associated with a higher rate…

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Seldinger Technique

One of the many pleasures of nephrology fellowship is learning how to put in temporary hemodialysis lines safely and efficiently using the Seldinger technique (the Swede is seen to the left). As an intern I constantly said to…

Hemodialysis Access Atlas

Here is a really excellent atlas covering all aspects of hemodialysis access function and malfunction which all renal fellows should read. We are indebted to Dr. Tushar Vachharajani, Marianne Neumann RN, and everyone at fistulafirst (www.fistulafirst.org/) for providing…

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PD: Catheter outflow failure

I recently saw a patient in our peritoneal dialysis clinic who had been ultrafiltering about a liter a day but who was now consistently draining 100ml less than his instilled PD solution volumes despite extended drain times and…

Backflow

Recently we had a patient who, despite good adherence to dietary restrictions and 4 hour dialysis runs, had a high pre-dialysis potassium and an inadequate URR. She had an AVF with a history of multiple central stenoses and…

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Femoral versus Jugular, part two

I have always been told that the jugular veins are preferable over the femoral veins when inserting temporary dialysis catheters. Various reasons are put forward for this including increased risk of infection and poor function of femoral catheters…

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