Latest update March 29th, 2024 12:59 AM
Feb 21, 2013 News
In an attempt to improve its delivery of renal care service, the Doobay Renal Centre Inc. has commenced offering to its patients Arteriovenous (AV) fistula which is recognised as the gold standard hemodialysis access.
At least six such procedures have been done at the facility this week although a total of about 20 have been done since it was introduced last year.
Speaking to this publication yesterday, Vascular Surgeon and Founder of the Centre, Dr Budhendranauth Doobay said that he first started undertaking the procedure at the Georgetown Public Hospital Corporation around March last year and a few were done at the West Demerara Regional Hospital.
However recent moves, he revealed, were made to have the procedure done at the Annandale, East Coast Demerara Renal Centre in a make-shift operating room.
He noted that without the AV fistula a renal failure patient cannot be dialysed with natural tissues.
This, he explained, is due to the fact that the catheter used to facilitate dialysis is usually inserted in the region of the upper chest or neck and is in fact a foreign body.
And according to him a foreign body can in no way last forever in the body of a patient.
“It can get infected and an infected patient can even lose his/her life…When there is an infection it can be really bad and we would have to take the catheter out,” said Dr Doobay, as he admitted that offering renal care is not without a few challenges.
He said that all good dialysis centres today are opting to do away with catheters and are now embracing the AV fistula procedure. Undertaken by Dr Doobay with the assistance of Dr Mursalene Gafoor, an eminent medical practitioner, and nurses of the Renal Centre, this procedure can cost as much as $300,000 but is being offered free of cost.
“We take a vein and connect it to the artery and it becomes big…it is an expensive operation and we are doing it free in our own operating room which we rigged up,” said Dr Doobay.
It has been medically proven that once kidney function goes below 10 to 15 per cent of its normal operation, dialysis treatments or kidney transplant are necessary to sustain life. There are two types of dialysis: hemodialysis and peritoneal dialysis. Both dialysis treatments are able to replace the kidney function of cleansing the blood toxins and removing extra fluids for people with kidney failure.
Catheter
versus AV Fistula
Hemodialysis is done to clean a patient’s blood by removing it from the body and passing it through a dialyzer or artificial kidney. The dialyser is a filter with two parts, one for blood and another for dialysis fluid called dialysate.
Usually for dialysis, a catheter is inserted into a large vein in either the neck or chest. However the catheter is usually a short-term option but there have been instances when it is used as a permanent access.
With most dialysis catheters, a cuff is placed under the skin to help hold the catheter in place. The blood flow rate from the catheter to the dialyzer may not be as fast as the AV fistula.
Added to this, catheters have a greater tendency to become infected than the other access types because the device is both inside and outside of the body. A catheter therefore must always be kept clean and dry thus swimming or bathing is usually restricted. Getting dressed may disturb the catheter at the exit site, so care needs to be taken.
However, an AV fistula is created by connecting a vein to an artery using a soft plastic tube. After the graft has healed, hemodialysis is performed by placing two needles; one in the arterial side and one in the venous side of the graft. The graft allows for increased blood flow.
Grafts tend to need attention and upkeep. As such patients at the Renal centre will be exposed to sensitisation sessions on how to ensure that theirs are well cared for in order to ensure that the optimum result is maintained, officials there said.
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