Welcome to the third chapter of the lipo-apheresis story. In today’s blog, I’ll cover vein mapping and what life was like when Kevin had a hemodialysis catheter. Note: This is the text only version. If you are interested in seeing the pictures, you can look at the "photos included" version.
In order for Kevin to start his lipo-apheresis treatments as soon as possible, his doctors sent him to a vascular access office so he could get a hemodialysis catheter installed. This allowed the lipo-apheresis machine access to a significantly larger blood flow than could be achieved with regular needles into a typical vein. Normally this type of access is used for kidney dialysis patients. In Kevin’s case, it was the best way to jump start the treatments while waiting for the fistula to be created, which would take three months and two surgeries to complete. (A fistula is the joining of an artery to a vein in order to create a “super-vein” for use with kidney dialysis or lipo-apheresis.)
The first step to prepare for the fistula surgery was a vein scan and mapping. Doctors at the vascular access office used ultrasound and x-rays to measure the size of the largest vein in Kevin’s left arm. The nurses and doctors were kind enough to allow me into the surgical suite to watch the process.
After the vein mapping, the information was sent to a highly specialized vascular surgeon, and Kevin was scheduled for the fistula surgery. In the meantime, Kevin’s lipo-apheresis treatments began about a week after the chest catheter was installed.
We weren’t sure what to expect for the first treatment. We showed up at the dialysis center at 8:30 where we met Anthony, the lipo-apheresis technician. His warm and friendly personality put us at ease. It took Anthony about 15 minutes to hook Kevin up, start the machine, and then treatment was underway.
The catheter tubes are hooked to an arterial intake line and a venous return line. The blood is pumped from the body, into the machine, through the specialized lipo-scrubbing filters (where the magic happens: LDL and triglycerides remain trapped in the filter). The fat from the blood is sent into a collection bucket and the clean blood is mixed with saline and Lactated Ringer's solution, then warmed and sent back into the Kevin. Heparin is used to prevent the catheter and other lines in the machine from forming blood clots. The first treatment took over four hours and we neglected to bring any food. By the time we headed home, we were both starving and Kevin was very tired.
In the days and weeks following its installation, we learned a lot about taking care of a hemodialysis catheter. Because the catheter tubes go directly into the jugular and down to the heart, keeping the area free from dirt and deadly microbes was critical. The doctors and nurses warned us many times how easily caths can become infected. I used a combination of alcohol swabs, peroxide, and pre-soaked betadine sticks. After each cleaning, I put a fresh gauze pad on the exit point and over the stabilization wings. The trick was finding fresh skin to affix the tape; after a few weeks the entire area was irritated from constant application and removal of medical tape.
Things we took for granted changed after Kevin had the cath installed. Taking a shower was now a two-person job. We have a hand-held attachment in our shower, which allowed us to control the water. Getting tap water on the cath site was a big no-no. There are clear plastic bandages to protect the catheter to make showering easier, but we chose not to use them. Kevin had to wash his face and hair in the sink. We kept a heavy towel on his shoulder to protect the cath from any incidental splashes. It wasn’t fun, but we got it down to a science. Having a very short haircut made it a little easier.
Even though the cath was no picnic, it was worth the hassle. The first lipo-apheresis treatment was a huge success. Initially it wore him out; it took about a day or two for Kevin to bounce back. Once he started feeling better, he REALLY felt better! We started to notice small changes like his toes were turning pink and were warm to the touch. Kevin also mentioned he had more feeling in his toes and a lot more energy overall. It seemed to make sense; now that his blood was normal viscosity, blood flow was vastly improved. When he exercised, his output was much higher than it had been in previous months.
In tomorrow’s blog, I’ll share what happened when the cath developed a partial clog and photos after Kevin’s fistula surgery. I’ll also reveal why Kevin had to stop his treatments and wait for the fistula to mature.
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