Managing Ischemic Pain After Dialysis Access Surgery: A Patient's Journey

After undergoing dialysis catheter placement, ischemic pain suddenly began during the recovery period?

My father had an emergency myocardial infarction at the end of January and was urgently started on dialysis.
Due to the emergency situation, he has been using a neck catheter for dialysis.
By the end of February, after regaining some strength, he decided to have a fistula created in his left arm.
After evaluation by the physician, an artificial graft was used for the fistula.
The surgery went well, and although there was some swelling, he was able to move his fingers normally without any other significant issues.
However, after the swelling in his left arm subsided, he suddenly began to experience severe soreness and weakness (almost unable to move his fingers).
This condition persisted for a week without significant improvement.
The nephrologist at the dialysis center could not provide a specific diagnosis, so he was referred to orthopedics, emergency medicine, and cardiology, where he was diagnosed with pain and swelling due to poor blood circulation.
He was prescribed medications to enhance circulation and anticoagulants.
This morning, due to a medication error, my father took the circulation-enhancing medication before dialysis, which caused low blood pressure during the procedure.
The low blood pressure resulted in unbearable pain in his arm.
Eventually, the dialysis team adjusted the artificial kidney to minimize the dehydration rate, allowing the treatment to be completed (though it was still finished half an hour early).
However, it is unclear if this has affected his condition, as my father continues to experience occasional pain in his arm after returning home.
The pain has significantly impacted his quality of life; although it typically lasts only a few seconds, the recurring episodes are mentally exhausting for him.

I would like to consult about the following:
1.
The doctors who have seen him are puzzled by the situation of "everything was normal during recovery, and then suddenly, on a certain day, he started experiencing soreness and weakness." So far, no doctor has provided an explanation for this.
The general diagnosis remains that the excessive blood flow diverted by the artificial graft has caused issues with blood circulation in the hand.
Is it possible that this sudden onset of soreness and weakness could be due to other problems?
2.
The symptoms of soreness and weakness have persisted for over a week, and my father's finger mobility has not shown significant improvement, even with medication (though he has not been on medication for long).
I am particularly concerned about the possibility of muscle atrophy.
The doctor prescribed a three-month course of medication before deciding whether to reduce the artificial graft.
Three months is a considerable amount of time, and I am worried that this could extend into the critical treatment window.
How long should we wait without improvement before returning for a follow-up or considering surgery?
3.
When ischemic pain occurs, my father is extremely uncomfortable.
Are there better ways to alleviate this? We have tried pain relievers and local anesthetics like muscle relaxants, but they have had little effect.
If the treatment duration is long, I hope to find ways to make him more comfortable during the process.

Su Xiansheng, 30~39 year old female. Ask Date: 2023/03/15

Dr. Wu Xueming reply Cardiology

It is recommended that you consult a cardiac surgeon regarding your questions about surgery.

Reply Date: 2023/03/15

More Info

Managing ischemic pain after dialysis access surgery can be a challenging journey, especially when complications arise unexpectedly. Your father's situation, following his myocardial infarction and subsequent initiation of dialysis, highlights the complexities involved in vascular access procedures and the potential for ischemic pain due to compromised blood flow.

1. Understanding the Sudden Onset of Pain and Weakness: The sudden onset of severe pain and weakness in your father's hand after a period of normal recovery can be perplexing. This could be attributed to several factors, including vascular complications such as thrombosis (clot formation) or stenosis (narrowing of the blood vessel), which can lead to reduced blood flow to the hand. The fact that the pain and weakness developed after the swelling subsided suggests that the underlying vascular status may have changed, possibly due to the artificial graft not functioning optimally. Other potential causes could include nerve compression or irritation, which can occur post-surgery, especially if there is swelling or hematoma formation. It is crucial to communicate these concerns with the healthcare team, as they may need to perform imaging studies, such as Doppler ultrasound, to assess blood flow and identify any vascular issues.

2. Monitoring Recovery and Muscle Atrophy Concerns: Given that your father's symptoms have persisted for over a week without significant improvement, it is understandable to be concerned about muscle atrophy and overall recovery. Muscle atrophy can occur when there is prolonged disuse or lack of blood supply. If your father’s hand function does not improve within a few weeks, it may be prudent to return to the physician for a reassessment. The timeline for returning to the doctor can vary, but if there is no improvement in function or if symptoms worsen, seeking earlier intervention is advisable. The healthcare provider may consider adjusting the treatment plan, which could include further imaging or possibly surgical intervention to address any vascular issues.

3. Managing Ischemic Pain: Ischemic pain can be particularly challenging to manage, especially when conventional pain relief methods are ineffective. While medications such as analgesics and muscle relaxants may provide some relief, they often do not address the underlying issue of blood flow. Non-pharmacological approaches may also be beneficial. These can include:
- Physical Therapy: Engaging in gentle exercises, as tolerated, can help improve circulation and maintain muscle strength.

- Heat Therapy: Applying warmth to the affected area may help alleviate discomfort and promote blood flow.

- Positioning: Elevating the arm or using compression garments may assist in managing swelling and improving circulation.

- Alternative Therapies: Techniques such as acupuncture or transcutaneous electrical nerve stimulation (TENS) may provide additional pain relief for some patients.

In conclusion, your father's experience underscores the importance of ongoing communication with his healthcare team regarding his symptoms and concerns. It is essential to advocate for timely evaluations and adjustments to his treatment plan as needed. The management of ischemic pain and recovery from dialysis access surgery can be complex, but with appropriate interventions and support, there is hope for improvement in his quality of life.

Similar Q&A

Understanding Thigh Pain in Diabetic Patients on Dialysis

Hello Doctor: I have had diabetes for 40 years and have been on dialysis for 6 years. Currently, I am troubled by thigh bone pain, which makes walking difficult, and I am unsure of the cause. Rehabilitation and electrical therapy have been ineffective. An orthopedic doctor diagno...

Dr. Lin Shunfa reply Internal Medicine
1. The text does not describe the dialysis situation, such as whether there were any discomfort symptoms during dialysis, low blood pressure, cramps, etc., so it may not be possible to determine if there is a direct correlation with dialysis. It is recommended that you consult yo...

Understanding Heart Discomfort During Dialysis: Causes and Solutions

Dear Dr. Wu, I have a family member, a 30-year-old female, who has been undergoing dialysis treatment for nearly two years. Recently, she experienced a sudden myocardial infarction and underwent cardiac catheterization and coronary artery bypass grafting, which was relatively su...

Dr. Wu Jiyu reply Internal Medicine
Based on your inquiry, the hemoglobin measurement is approximately 21-25, which is low. After blood transfusion, you may discuss with your physician whether erythropoietin (EPO) or iron supplements are adequate or if there are other bleeding issues (such as gastrointestinal bleed...

Understanding Discomfort in Dialysis Patients: Heat Sensation and More

Dear Doctor, My elder family member is 70 years old and has been undergoing dialysis three times a week for over three years. Recently, we have noticed that if he misses a dialysis session or goes two days without it, he experiences several uncomfortable symptoms: 1. Dizzines...

Dr. Lin Wuxuan reply Internal Medicine
Hello: Based on your description, these symptoms may be caused by uremia. Hemodialysis treatment (commonly referred to as dialysis) is not a panacea and cannot be compared to the natural functions of healthy kidneys. It can only assist the body in eliminating some water-soluble t...

Understanding Peritoneal Dialysis Complications: A Three-Month Hospital Journey

Hello Dr. Ke, my mother has been on peritoneal dialysis for eleven years and her condition has been stable without any episodes of peritonitis. However, from mid-December to the end of December last year, she experienced difficulties with drainage and frequently visited the hospi...

Dr. Ke Fangxu reply Surgery
Due to the incomplete nature of your inquiry, we are currently unable to provide you with a response. If needed, please feel free to ask again and present your question in full detail. Thank you!