Q: My 69 years old diabetic mother is hypertensive and is on haemodialysis for the last one and a half years. Initially the doctor had put jugular in the right side of her neck after that they tried fistula on the right wrist, which failed because she has weak veins. So the doctors inserted a permacath in her chest through which they do the dialysis. But she got infection in the permacath and it had to be removed. Now it has been 4 weeks since the fistula is created. The doctors are saying it would take at least 6 to 8 weeks for the swelling on her hand to go away. Due to the accident they have inserted jugular cannula in the left side of her neck from which they are performing dialysis for the last one month and now there is no flow in the jugular cannula and today they are admitting her again to get colour doppler done to insert another jugular cannula on right side. We consulted two other doctors and one suggested that we should go for peritoneal dialysis and the other says we should wait and see if the fistula develops. Please suggest. What should we do?

A:The closing of veins after multiple haemodialysis is common. Jugular and subclavian veins are the usual ones used. Vascular surgeon can be consulted for a shunt surgery, with or without vascular graft. If veins are not available, last option is peritoneal dialysis which can be done at home.