1st attack of syncope...

with the name Of Allah the most gracious the most merciful....

Today,somewhat early in the morning(8.30 a.m) and we already here in the dialysis unit just want to make sure that we came before Dr Suhair( Renal Chief Department).TUP..TUP....when the clock showed it's already 9 a.m but still ,our beloved dr.didn't show herself.Then, we just realised it's not Dr Suhair that will teach us today as the responsible doctor came at 9.20 a.m.It's OK though...huhu...So,did u guys  familiar with the word "dialysis"??

ehem...ehem...here i want to explain...actually dialysis is some sort of an artificial process of getting rid of waste product  from the blood. This process is naturally done by our kidneys. Some people, however, may have failed or damaged kidneys which cannot carry out the function properly  and they may need dialysis. In other words, dialysis is the artificial replacement for lost kidney function (renal replacement therapy). 

there are two type of dialysis which are hemodialysis or peritoneal dialysis.Dr said here in Egypt it's not soo common to do PD opposite to Malaysia where PD is quite common.

In hemodialysis the blood circulates outside the body of the patient - it goes through a machine that has special filters. The blood comes out of the patient through a catheter that is inserted into the vein. The filters do what the kidney's do; they filter out the waste products from the blood. The filtered blood then returns to the patient via another catheter.  

Usually patiens need to be prepared for hemodialysis with minor surgical procedure called arteriovenous (AV) fistula is done.Fistula is a connection between an artery and vein .This is important to increase more blood flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis more easier.This fistula usually take about 1-3 months to develop.

Hemodialysis usually done about 2-3 session/week and 1 session last about 3 to 4 hours The duration of each session depends on how well the patient's kidneys work.It's somewhat tiring kan...huhu

Usually for permanent access( long term dialysis) we do it in the forearm (radiocephalic , radiobasilic, brachiocephalic and brachiobasilic fistula). But,in the patient with acute kidney injury and need immediate access or only for short time dialysis we can insert a catheter elsewhere like in the subclavian,internal jugular or femoral vein.

Fortunately,today we had a young female patient who need immediate dialysis.So,responsible doctor started to prepare the things needed for the procedure.Dr put some betadaine n give local anasthesia to the patient.So,!!patient was fully awake when the procedure was done.

                     doctor withdrawed venous sample from jugular vein just to make sure 

                        we were in the right position(in the vein) and not in the artery.It will be catastrophic
                          event if we accidentally insert guide wire inside an artery near to the vein.

but when dr.tried to insert the guide wire it can't enter easily as if there was 

something obstructed the pathway...

So,doctor tried again and after 3rd attempt of withdraw and put guide wire repeatedly,suddenly i felt very dizzy.I hold my friend beside and told her"azzah...pening2".Then,my vision became blank totally and my leg became weak and can't support my body anymore..My friends immediately brought me to the nearest bed,raised my leg and gave me water to drink.After a while my vision became clear again.

OH MY!!!!!This is my 1st attack of syncope so,it was somewhat shocking to me.My friends and I assumed it's due to vasovagal attack as the procedure was somewhat extreme( patient herself stated it's painful but still dr repeated the procedure even she failed for many times)This trigger maybe had disturb my emotional state resulted in vasovagal syncope — a brief loss of consciousness caused by a sudden drop in  heart rate and blood pressure, subsequently reduces blood flow to my brain.

After a while,we found that still dr can't made the access and dr assume that maybe the vein was thrombosed and prepared patient for doppler ultrasound.huhuhu...soo pity to the patient as this procedure was'nt necessary if doctor did doppler/duplex first.But,here in Egypt we don't do that-they don't want to waste money for that.

p/s::may this attack become the 1st and the last one for me....huhuhu