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Hemodialysis is the process of cleaning the patient’s blood outside the body. Learn more about this renal replacement therapy option.

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What is vascular access? What are the different types of accesses for hemodialysis? Does vascular access require surgery? Adina Voiculescu, M.D., FASDIN, General and Interventional Nephrologist at Brigham and Women's Hospital and Assistant Professor at Harvard Medical School, discusses the different types of vascular access, such as AV fistulas and AV grafts, and how to stay healthy while on hemodialysis.

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0:00 - Intro
0:29 - Peritoneal dialysis & Hemodialysis
0:44 - Types of access to perform dialysis
1:48 - Recommendations

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Hemodialysis: Types of Accesses for Kidney Dialysis and How to Stay Healthy | Mass General Brigham
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Starting dialysis often means creating a new normal for yourself and your family. There’s a lot to think about, from choosing a treatment option, to finding new ways to enjoy your favorite activities, to managing a new diet. The FIRST30 program is all about helping you through this period of adjustment.

Find out more at KidneyFund.org/FIRST30.

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Remember… don’t be scared, BE PREPARED!

Dr. Katherine Scovner from the Division of Nephrology at Massachusetts General Hospital discusses kidney dialysis.

What is hemodialysis and how does it work? Who needs it? How do you prepare for it? In the United States, over 30 million Americans have kidney disease, and sometimes, kidney disease progresses to kidney failure or end-stage renal disease. When this happens, you cannot survive unless you have a kidney transplant or some form of dialysis. So today we're going to talk about hemodialysis.

Your kidneys are the two kidney bean-shaped organs that are located in your lower back, or in your flanks. And the kidneys are responsible for filtering out or cleaning your blood. They get rid of excess waste, excess toxins, and excess fluids. If your kidneys stop functioning, then you develop renal failure or end-stage renal disease.

What is Hemodialysis?
Hemodialysis, or blood dialysis, is the filtering of your blood outside of your body. So, if your kidneys stop working properly, the hemodialysis acts as a substitute kidney. Now it's important to note that hemodialysis does not actually correct your own kidney function. It does not fix or treat your kidneys.

#hemodialysis #drfrita

What is The Dialyzer?
The dialyzer is actually the filter. It's the main powerhouse of the hemodialysis system, and it is what actually acts as the substitute kidney. In the dialyzer, you have these hollow fibers that run through it, and these fibers are bathed in something called dialysates, or dialysis fluid.

How Often Are Patients Treated With Hemodialysis?
Most patients who are on hemodialysis are on it between three and six hours, about three days a week, especially if they go to a center.

How Does Hemodialysis Work?
So when you are on dialysis, how does your blood get from your body to the hemodialysis machine and then back to your body? Well, it does so through tubes, and those tubes are connected to your access, and we'll talk about access in just a moment. But as far as the tubing, the tubing is connected to your body.

Types Of Hemodialysis Access
Arteriovenous Fistula or AV Fistula
The AV fistula is the gold standard as far as hemodialysis access is concerned because it gives you the most efficient hemodialysis and it is the least likely to be infected.

Arteriovenous Graft or AV Graft
The AV graft is very similar to the AV fistula in that you still have a surgically connected artery and a vein, usually in the arm, but in the case where if you have veins that are rather thin or arteries that are thin and maybe too weak in order to really give you a properly functioning, substantial AV fistula, then the vascular surgeon may opt to add an artificial material in order to make that shunt a little stronger, or little more durable. And so, an AV graft is another option for dialysis access.

Catheter
If you're in a situation where you need temporary dialysis, or if you have acute kidney injury, then you may have a temporary Vascath placed, and it's usually placed in a vein of the neck, the internal jugular vein, or it can be placed in the groin, or in the femoral vein.

Who Needs Hemodialysis Treatment?
How do you know if you need hemodialysis, and when is it time to prepare? Well, if you follow up with your kidney doctor (nephrologist) regularly, he or she will be watching your labs. They'll be able to see those signs of your kidneys not functioning properly.

Watch this video to learn how and when to change a dressing for a child with a hemodialysis catheter. You should change your child's dressing if it becomes soiled with water or blood or if it comes off at home. Keeping a clean dressing on your child will limit risk of infection.

In this instructional video, Director of Critical Care Nephrology, Sevag Demirjian, MD goes over the steps for in-hospital production of ultra-pure continuous hemodialysis fluid.

By using the information in this video and/or any other materials made available by Cleveland Clinic related to the dialysate solution, you agree to comply with and be bound by the terms of the Permissive Use Agreement, a copy of which is available at https://bit.ly/3f9lN4j

Eric's Home Dialysis

If you have an active lifestyle or are often on the go with work, travel or family, then peritoneal dialysis at home may be the right choice. Home peritoneal dialysis offers additional freedom and flexibility as a treatment option that’s closest to natural kidney function and may require fewer dietary restrictions and medications. To learn more about Home PD, visit https://www.FreseniusKidneyCar....e.com/ckd-treatment/

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We are looking for 5 patients with knee pain who want to get significantly better in the next 30 days. Click this link to let me know you're interested and learn more.

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If you suffer a knee injury, what do you do about it? Should you be concerned? On one hand, you could give it a few days to see if it gets better on its own. How can you know if you risk making the problem worse? In this Ask Dr. Geier video, I offer four signs you have a serious knee injury that could require surgery.

Please note: I don't respond to questions and requests for specific medical advice left in the comments to my videos. I receive too many to keep up (several hundred per week), and legally I can't offer specific medical advice to people who aren't my patients (see below). If you want to ask a question about a specific injury you have, leave it in the comments below, and I might answer it in an upcoming Ask Dr. Geier video. If you need more detailed information on your injury, go to my Resources page: https://www.drdavidgeier.com/resources/

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SWELLING
If you have a knee that is much more swollen than the opposite knee, especially if the swelling developed soon after you got hurt, then it could be a sign of structural damage. While a small amount of swelling could be normal or a sign of inflammation in the knee, a knee that is really swollen and much larger than the other knee could represent a fracture, torn ACL or other ligament or some other damaged structure.

INABILITY TO FULLY STRAIGHTEN YOUR KNEE
Pain can make it difficult for you to straighten your knee. But being unable to get your knee completely flat can be a sign of an injury like an ACL tear or meniscus tear.

LOCKING OF THE KNEE
Locking is a term orthopedic surgeons use to describe a knee that gets stuck in a certain position. Maybe you can straighten it to a certain point, but it gets stuck around 30 degrees short of fully straight. Or you can’t bend it past a certain point because something inside the knee is blocking it. Catching is a milder form of the same problem, where you can get to the point that the motion stops, but you can twist or rotate your knee past that point.

BUCKLING OR GIVING WAY
Having the tibia (shin bone) shift out from under the femur (thigh bone) usually represents an ACL injury. If your knee buckled during the traumatic injury and keeps happening in the days after the injury, you risk doing more damage to the other structures inside the knee.

This list is not comprehensive, so if you are concerned about your knee injury or knee pain, it never hurts to see your doctor or an orthopedic surgeon.

How to Know If You Have a Serious Knee Injury or Problem
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Bob & Brad discuss how to know if you have a serious knee injury. They show you what to look for and what you should do.

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It depends upon which ligament is injured. If it is medial collateral ligament you feel pain when you walk ,sit and stand and you will be liming as well. If it is anterior cruciate ligament you feel pain when you walk on uneven ground.

How Do I Exercise An Injured Knee?

Bob and Brad discuss how to exercise an injured knee.

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