Glossary

Buttonhole technique

A way to put needles into a fistula that can reduce needle pain and the chance of large bulges or bumps. Needles are placed into the exact same holes at the exact same angle for eight or so treatments in a row. Tunnel tracts form, like pierced earring holes. The tracts then guide the needles to the right spot. Blunt needles are used once the tracts form, to avoid cutting the tracts. It's best if the person with the fistula starts the Buttonholes, as this boosts the chance of using the correct angle. Scabs must be removed with great care to avoid infection.

Care Partner

Someone who is on hand when a dialysis treatment is done. He or she may be an extra pair of hands—or may do the whole treatment. It is best for the person on dialysis to do as much as he or she can, especially putting in the needles. During training, ask for a list of dialysis tasks from the training nurse. Work out who will do which tasks and how you will change this breakdown of tasks if you need to.

Catheter

A plastic tube that can be placed in the body. In HD, catheters are used to gain access to the blood vessels. A central venous catheter can be placed into a vein in the neck, chest, or groin and threaded into the heart. A PD catheter is placed through the wall of the chest or belly so the lining of the peritoneal cavity can be used as a filter to clean the blood. Since a catheter is both in and outside the body, infection is always a risk. Great care must be taken to keep it clean and dry.

Continuous Ambulatory (walking around) PD (CAPD)

Exchanges are done by hand, most often four times a day: breakfast, lunch, dinner, and bedtime.

Continuous Cycling PD (CCPD)

Using a cycler machine to do PD exchanges at night during sleep.

Daily Home Hemodialysis (Daily Home HD)

2.5-4 hour treatments done 5 or 6 times a week. This way there is no 2 day gap without any blood cleaning. This means there will be fewer limits on what you eat and drink than if you did standard in-center treatments.

Dialysate

A solution made of purified water and a special mix of chemicals. During dialysis, wastes and excess water in the blood flow into the dialysate, which is then thrown away.

Dialysis

A life-saving process that removes wastes and extra fluid from the blood of someone whose kidneys don't work. There are two main types: hemodialysis (HD) and peritoneal dialysis (PD).

Exchange

In PD, an exchange is the process of draining out used dialysate and replacing it with fresh. An exchange can be done by hand (see CAPD) or using a cycler machine (see CCPD).

Extended (Nocturnal) Hemodialysis

8 to 10 hours of hemodialysis in a single treatment. This means the treatment can be very slow and gentle, which is also easier on your heart. This kind of treatment can be done at home as well as at clinics that offer it.

Fistula

An arteriovenous fistula is made when a surgeon sews an artery to a vein under the skin of an arm. A fistula is the best type of vascular access for HD. It is made only of living tissue, and can last for years—or even decades—with good care. It's best if the person with the fistula puts in the needles, even if treatments are done in a clinic. Fistulas are far less prone to blood clots or infection than other types of access, though these can still happen. The Buttonhole technique can be used to place needles in a fistula, which can help it last longer and look better.

Graft

An arteriovenous graft (AVG) is made when a surgeon sews an artery to a vein under the skin of an arm, using a piece of man-made vein. A graft is the second best type of vascular access for HD. Since a graft includes man-made tissue, it has to be replaced at least every 5 years or so to prevent rupture. A graft is also more prone to blood clots and infection than a fistula. But, since a graft is completely under the skin, it is still much safer than a catheter for HD. It's best if the person with the graft puts in the needles, even if treatments are done in a clinic.

Hemodialysis (HD)

Treatment that cleans wastes and excess water out of the blood by passing blood through a filter called a dialyzer. Inside the filter, blood flows through the inside of thousands of hair-thin hollow fibers. Dialysate fluid flows around the outside of the fibers. Wastes and water flow through microscopic pores in the hollow fibers and into the dialysate, which is then washed down a drain.

Hormones

Messages one part of the body sends to another.

Peritoneal Dialysis (PD)

A treatment that cleans wastes and water out of the blood, using the lining of the inside of the abdomen (peritoneum). A catheter is placed in the belly or chest and used to fill the belly with sterile PD fluid. Capillary blood vessels in the peritoneum filter the blood. Wastes and water flow into the fluid, which is then drained and replaced with fresh fluid in a process called an exchange.

Peritoneum

The inner lining of the abdomen that also covers the internal organs. This membrane is rich in blood vessels, and is used as a filter to clean the blood in peritoneal dialysis. Care must be taken to keep germs out of the abdomen to prevent peritonitis (a painful infection).

Vascular Access

A way to reach the blood for HD, created by a surgeon. Your blood vessels include arteries, which carry blood from your heart and veins, which bring blood back to your heart. Veins are close to the surface of your skin and easy to reach with dialysis needles. But, veins do not have enough blood flow for HD. Arteries have enough blood flow, but they are deeper and harder to reach. There are three types of access: fistula, graft, and catheter. Fistulas and grafts both connect a vein to an artery. A catheter for HD is placed into a large, central vein. Learn more in Kidney School Module 8 - Vascular Access: A Lifeline for Dialysis.

Work-Friendly

Types of treatment that make it easier to keep a job. These treatments are not done during the work day—or may be able to be done at work (as with PD). They let you have enough energy and mental focus to put in a full work day. You won't miss a lot of work because you are in the hospital. You can travel if you need to for work. PD and home HD are work friendly. So is in-center extended HD.