No surgery, no dialysis, for end stage renal patients

Many persons cannot afford the thousands of dollars being charged by vascular surgeons at private facilities to have an Arteriovenus fistula (AV) procedure done. This is regarded as the best option for persons on long term dialysis.

An access has to be created in the body to allow blood to be carried from the body dialysed and returned to the body. This can be done via a special catheter inserted into a major vein generally in one of the large veins in the neck extending into the large central vein near the heart so that blood can be repeatedly drawn and dialysis done. This should be used for three months.

Another method is the Arteriovenous (AV) graft which is created by connecting a vein to an artery using a soft plastic tube. After the graft has healed, hemodialysis is performed by placing a needle in the artery side and another in the venous side of the graft. The other option for access is AV fistula in which a direct connection is made from an artery to a vein. Once the fistula is created it is part of the body. It can take weeks to months before the fistula matures for hemodialysis to be done.

A source told Newsday that the AV fistula in the arm was the best option for dialysis patients.

“If there are two patients starting on dialysis and one has an access in the arm and another in the neck. The patient with the access in the arm lives longer. There is less risk of infection.”

He said one of the problems locally is that people referred for dialysis go to EWMSC when their condition is so severe they require immediate dialysis. They do not have the luxury of having a fistula inserted and waiting months for it to heal. He said the quickest procedure is to have the temporary access. Unfortunately, the source said some patients have been on temporary catheters for a year and more.

“If you leave the tube in the neck that vein can collapse and when you pull out the tube the vein closes up.”

The source said EWMSC has surgeons who can do the access procedures but theatre time is not allocated for this purpose. Instead, the procedures are being done irregularly when the surgeons can slot in a case. Newsday learnt that an appeal has been made to the North Central Regional Health Authority to have a surgeon dedicated to do access lines and fistulas. The number of persons in need of dialysis has significantly increased and at least 50 patients are awaiting access procedures to be able to get dialysis.

Dialysis patient Sherry Ann Charles is on her fourth neck catheter but it fell off last Wednesday. “I don’t know what the problem is with these things,” she told Newsday.

The 33-year-old Maloney resident said she wanted to get an access in her arm for dialysis. She went to a private doctor and was told $10,000 and two weeks after the cost was $15,000. She was told the reason for the increased cost was “everything going up right now”.

“They are not doing the fistula or graft at Mt Hope anymore. Some of us are living on $1100 disability grant. I am on a strict vegetarian diet and vegetables are very expensive, plus I have to buy some medications.”

She said having a catheter in her neck has caused her to be ridiculed as an “alien” and people asking many questions. “It’s a real stigma. You have to be strong.”