Psychological and Clinical Issues

Abstract

The dominant psychological trait of dialysis patients is that of submission and indifference probably borne out of old age, repeated doctors’ visits, and the enduring chronicity of their underlining medical conditions. If there is any aggressivity or unhappiness, it is usually directed at the staff at the reception rather than at the interventionist.

Shaking the patient’s hand may allow diagnosis of overlooked distal ischemia. A flat arterialized vein accompanied by ecchymoses is very suggestive of an inflow problem. A tense AVF whereby the thrill is replaced by hyperpulsatility indicates a venous outflow stenosis. Arm and/or facial edema, unless proven otherwise, denotes the presence of a tight central vein stenosis. Aneurysms are a common occurrence and usually develop at cannulation sites as a result of repeated punctures which weaken the wall of the access. There are no specific or definite size criteria for surgical correction of these aneurysms. Any patient presenting to the intervention suite with cutaneous necrosis in the cannulation areas should be admitted and referred urgently to a surgeon after dilation of the underlining stenosis.