The Future of Dialysis Care – Harnessing hemostatic dialysis bandages for effective vascular management

hemostatic dialysis bandages

 

Dialysis Overview

Kidneys help filter waste from the blood, keep body fluids balanced, and produce essential hormones. When kidneys fail due to disease or injury, dialysis becomes a lifesaving treatment. In people with end-stage kidney disease, or kidney failure, dialysis takes over the kidney’s role by removing extra waste and fluid from the blood.

When is Dialysis Needed?

Dialysis is recommended when a person’s kidney function drops to 10-15%. This typically occurs in the final stage of chronic kidney disease [1]. Dialysis can also be required in cases of acute kidney failure, where the kidneys suddenly lose their ability to function.

What is Haemodialysis?

Haemodialysis is the most common form of dialysis. It performs the job of the kidneys when they can no longer function properly. This process involves drawing blood from the body, filtering it through a machine called a dialyzer (an artificial kidney), and then returning the cleaned blood back to the body. Haemodialysis helps:

  • Remove extra salt, water, and waste products
  • Maintain safe levels of minerals and vitamins
  • Control blood pressure
  • Support the production of red blood cells

Dialysis Access Points

When it comes to hemodialysis, selecting the right type of access is crucial for effective treatment. Each type of access has its own advantages and disadvantages. Here’s a quick overview of the four main types of dialysis access: Central Venous Catheter (CVC), Arteriovenous (AV) Fistula, Arteriovenous (AV) Graft, and Peritoneal Dialysis (PD) Catheter [2].

1. Central Venous Catheter (CVC)

A CVC is a temporary access option, often used in emergencies. A flexible tube is inserted into a central vein in the neck, chest, or groin.

Fig.1: Central venous catheter inserted for haemodialysis, showing blood flow from the body to the dialysis machine and back to the right atrium of the heart

Advantages:

  • Quick to place and ready for immediate use
  • Simple outpatient procedure

Disadvantages:

  • Higher risk of infection and clotting
  • May damage veins
  • No swimming or bathing due to infection risk

2. Arteriovenous (AV) Fistula

An AV fistula is created by connecting an artery to a vein, allowing increased blood flow. It is considered the “gold standard” for long-term dialysis access [2].

Fig.2: Arteriovenous fistula in the forearm, showing the connection between an artery and vein to allow increased blood flow for haemodialysis 

Advantages:

  • Long-lasting (can last for years)
  • Lower risk of infection and clotting
  • No need for catheters

Disadvantages:

  • May require temporary access due to delayed or failed maturation [3]
  • Needles required for dialysis sessions

3. Arteriovenous (AV) Graft

An AV graft is similar to a fistula but uses a synthetic tube to connect the artery and vein, often used for patients with small or damaged veins. In some cases, the graft placement can be performed in an outpatient setting, depending on individual circumstances and facility protocols.

Fig.3: Arteriovenous graft in the forearm, demonstrating the use of a synthetic tube to connect an artery and vein for reliable haemodialysis access

Advantages:

  • Ready for use within 3 to 4 weeks
  • Implantation process is generally less complex

Disadvantages:

  • Doesn’t last as long as an AV fistula
  • Higher risk of clotting
  • Needles still required for dialysis

4. Peritoneal Dialysis (PD) Catheter

A PD catheter is used for peritoneal dialysis, where a dialysis solution fills the abdominal cavity and filters waste through the peritoneum, effectively cleaning the blood.

Fig.4: Peritoneal dialysis setup, where a catheter is inserted into the abdominal cavity, allowing dialysis solution to filter waste through the peritoneum

Advantages:

  • No needles required
  • Home-based dialysis
  • Simple outpatient placement

Disadvantages:

  • High risk of infection
  • No swimming or bathing due to infection risk
  • May not be suitable for those with abdominal issues

Hemodialysis Complications

Vascular access complications are a significant challenge for chronic haemodialysis patients, often leading to frequent hospitalizations and financial strain. AV fistulas and grafts are often preferred over venous catheters because they carry a lower risk of issues like infection, thrombosis (blood clots), and stenosis (narrowing of blood vessels). However, AV fistulae are not without complications. These may include thrombosis, infection, bleeding, increased venous pressure, arterial insufficiency, aneurysm formation (a weakened bulge in the vessel wall), distal ischemia (reduced blood flow to extremities), and, in rare cases, heart failure [4].

The most common complications of vascular access include:

  1. Vascular Access Stenosis: During dialysis, the surgical connection between an artery and a vein—known as venous anastomosis—is crucial for maintaining steady blood flow. However, over time, this connection may narrow due to neointimal hyperplasia, a condition where cells multiply along the vessel wall, causing it to thicken. This thickening restricts blood flow, reducing dialysis efficiency and often necessitating medical intervention to keep the access functional [5].
  2. Vascular Access Thrombosis: Blood clots can form within the access, often triggered by stenosis, leading to complete blockage. This requires prompt intervention to avoid the loss of access [6].
  3. Catheter-Related Fibroepithelial Sheath Formation: A fibrous sheath can develop around tunneled dialysis catheters, causing catheter dysfunction and reduced blood flow. A procedure called balloon angioplasty is often used to restore normal blood flow [7].

These complications must be promptly managed to ensure the longevity and effectiveness of vascular access in dialysis therapy [8].

Dialysis Bandages Brands

Managing bleeding at dialysis access sites is critical, and several haemostatic dialysis bandages are designed to help:

Velseal® Patch

A ready-to-use dressing with a polymeric haemostatic pad, Velseal® Patch promotes rapid clotting, reducing post-dialysis bleeding time.

Fig.5: Velseal® Patch with absorbent material designed to promote rapid clotting and support wound closure for effective haemostasis

Celox™ Vascular

Made with chitosan, a natural polysaccharide, Celox™ Vascular controls surface bleeding from vascular access sites. It works independently of the body’s normal clotting mechanism and can be left in place for up to 24 hours.

 Fig.6: Celox™ Vascular, a haemostatic patch held in position, offering rapid clotting support for vascular access sites

Aidplast Sterile Haemostatic Pressure Plaster

This pressure bandage is used for haemodialysis patients when removing the catheter from the fistula. Its absorbent pad applies pressure to stop excessive bleeding.

 Fig. 7: Hemostatic plaster with sponge to secure and seal the puncture site effectively

SURGISPON® DIAL

SURGISPON® DIAL is an absorbable gelatin sponge designed for post-renal dialysis patients to effectively control bleeding at the puncture site. Its highly porous structure can absorb fluids 40-50 times its weight, promoting rapid platelet aggregation and coagulation [9]. The sponge activates thrombocytes upon contact with blood, aiding in fibrin formation. This process helps prevent the loss of natural clotting factors, offering a faster and more efficient hemostatic solution.

Fig. 8: SURGISPON® DIAL securely held for precise application

Fig.9: SURGISPON® DIAL application process, from placement alongside gauze at the catheter site to removal with saline irrigation for precise hemostasis management

Conclusion

Dialysis serves as a critical lifeline for individuals with kidney failure, effectively taking over the kidneys’ essential functions. However, the journey of dialysis treatment comes with its own set of challenges, particularly when it comes to maintaining reliable vascular access. The potential complications—such as infection, thrombosis, and stenosis—underscore the need for careful management and monitoring.

Innovations in hemostatic solutions, like specialized dialysis bandages, play a vital role in minimizing these risks, promoting quicker recovery, and enhancing the overall dialysis experience. By choosing the right dialysis access type and employing effective hemostatic measures, patients and healthcare providers can work together to ensure safe, efficient, and uninterrupted treatment.

Incorporating the latest advancements and adhering to best practices in dialysis care can make a significant difference, offering patients a higher quality of life and a smoother path to managing their condition.

Comments

Post a Comment

Popular posts from this blog

Revolutionizing Surgical Hemostasis: Introducing Surgi-ORC® Powder (Absorbable Hemostatic Powder)

Image
  In modern surgery, efficiently managing perioperative bleeding is crucial. Uncontrolled surgical bleeding poses significant risks to patient health and leads to substantial clinical and healthcare resource burdens. This challenge is particularly pronounced with an aging population and the rising prevalence of comorbidities and anticoagulant use. To address these issues, topical hemostatic agents have emerged as vital tools, promoting hemostasis where conventional methods fall short. These agents vary widely in properties, mode of action, ease of use, safety, and cost. Their selection often depends on the specific surgical scenario, bleeding situation, and patient’s health status. Exploring Topical Hemostatic Agents The current array of topical hemostatic agents comprises several types, each designed to meet different needs in the surgical setting: Mechanical Agents:  These are regarded as the simplest, safest, and most cost-effective. They offer a structural framework for hemostasis
Read more

Comprehensive Health Check-Up: A Commitment to Employee Well-Being

Image
Introduction In today’s fast-paced work environment, the health of employees can often take a back seat to the pressures of meeting deadlines and maintaining productivity. However, maintaining a healthy workforce is crucial for fostering a positive work environment and ensuring long-term organizational success. Regular health check-ups at the office serve as an effective means to address this challenge, ensuring that employees have access to necessary health assessments without the need to disrupt their work routines. The positive impact of these initiatives not only improves employee well-being but also reinforces the company’s commitment to a healthier workforce. This blog will delve into why these check-ups are crucial and provide insights into how they can be effectively implemented in the workplace. Aegis Lifesciences Leads the Way in Workplace Wellness It’s often said that prevention is better than cure, a principle that Aegis Lifesciences upholds in its commitment to employee he
Read more

Role of Surgi-ORC® Fibril and SURGISPON® in Posterior Fossa Tumor Resections

Image
  In posterior fossa tumor resections, Surgi-ORC® Fibril and SURGISPON® play crucial roles in facilitating a successful surgery and promoting optimal patient outcomes. Here's how they contribute to the surgical process: Hemostasis : One of the primary roles of both Surgi-ORC® Fibril and SURGISPON® is to assist in achieving hemostasis, which is the control of bleeding during surgery. Posterior fossa tumor resections can involve intricate procedures near sensitive structures such as the brainstem and cranial nerves, where bleeding must be carefully managed to maintain a clear surgical field and prevent complications. Surgi-ORC® Fibril and SURGISPON® are applied to bleeding surfaces to promote clot formation and minimize bleeding, thus enhancing visibility and surgical precision. Tissue Protection : During posterior fossa tumor resections, it's essential to protect delicate neural tissues from damage during surgical manipulation. Surgi-ORC® Fibril and SURGISPON® act as physical ba
Read more