167) American Kidney Foundation & Vascular Access

September 20, 2007
Thursday

Madison Hotel, DC: Breakfast is French toast with some sort of flaky stuff stuck to it… and it tastes thickly okay. Mostly I like the link sausage and bacon and coffee. It seems very luxurious to walk into a dining room and get your coffee and take a sip of the hot liquid and then mosey on over to a hotel pan of hot sausage and bacon steaming a welcoming aroma at you. What a way to live. I wistfully wish I was barefoot on this maroon ornate rug with my plate of sausage and my steaming hot coffee… and, yes… the Washington Post. I’ve been reading this paper for a few days now and I like it better than the Statesman. Duh.

We DPC's say “Hi” to each other, share breakfast tidbits of information, and slowly drift into the meeting room. Today there are more educational lectures and then more hill visits for the people who were on dialysis yesterday. And there is dialysis for us who visited the hill yesterday.

We start with Phyllis describing the work of the American Kidney Foundation, an incredibly motivated and effective group that collects money for dialysis patients who are not covered by insurance or by Medicare. These people do exist and they get help from AKF (...watch for more info here about AKF from Phyllis’ talk)

Next a person whose voice sounded unnerving to me (in a shrill, birdlike way) talked about secondary hyperthyroidism and it was nearly impossible for me to get much out of it since I wouldn’t move away from my judgments about her voice. Her shtick was cutsey and had lots of laminated props for people to hold and use. However, she had an informative folder of information so all was not lost for me. I’m sure others in the group thought she was fine… I am just too old and grouchy and anti-cutesy I think.

After Ms Cutesy we got to hear Dr. Mahoney discuss vascular access and I learned some new things from this guy. He reminded us that catheters for access are EVIL; AV Grafts ain’t so hots (cause dey gots da clots)*; and, of course, AV Fistulas like mine are the state of the art. According to the doc, right now only 65% of dialysis patients have AV Fistulas and DC is dead last in the country for reasons that aren’t quite clear (to him). To keep watch over your AV Fistula, Mahoney suggests:

1. Protect your fistula arm.
2. Never allow a PICC line placed in your fistula.
3. If you need a PICC line ask for a “right side central access line” which goes in the jugular vein.
4. Get familiar with your venous pressure; it should be ½ the blood flow rate.
5. Long bleeding after dialysis usually means problems with the fistula (blood flows where there is least resistance and when that means out the stick hole, there’s blocking somewhere).
6. Seek a fistula evaluation when there is prolonged bleeding, worse Kt/V, lower blood flow rate for a period of time, hard cannulations, swelling of the fistula, or a strong pulse in the fistula.
7. The easiest and safest way to clean out a blocked fistula is with an angioplasty (in and out in one day).
8. When you hold your arm straight up, the fistula should drain and deflate (shows easy blood flow back into body).**
   

What great information, huh? Afterwards, Mahoney checked out a number of our fistulas and said mine was “okey dokey”.

Notes:
* Mahoney on AV Grafts: Watch your BP. If it goes below 80 that’ll lead to clotting.

** Mahoney, D. Vascular Access. Lecture presented at the DaVita Patient Citizens Capitol Hill Advocacy Day Meeting. Washington, DC.