(Source: Dr. Wei-Wen Chang’s Facebook, Dec. 1, 2023) (Dr. Wei-Wen Chang: currently director of Linkou You An Internal Medicine Clinic / Hemodialysis Center)
When caring for dialysis patients, if we find access-related problems such as venous pressure that has recently been too high during dialysis, or difficulty stopping bleeding after needle removal, we help refer the patient to a vascular surgeon and ask the surgical team to help.
Patients who have never had their access treated always ask me anxiously before going: “Will it hurt? How long will it take?”
“I heard from patients who went before that the few seconds when the vessel is stretched hurt a lot, but it depends on the person; not everyone finds it very painful.” As I answered, I always felt a bit guilty, because in fact I had never seen how surgeons handle it in the operating room.
When I worked at Taoyuan Hospital, I wanted to find a chance to observe operations with a vascular surgeon I knew, to see how they solve problems for our dialysis patients; but with busy clinical duties I could never find the time. (Once I did go into the operating room to see how a general surgeon places a peritoneal dialysis catheter.) Then I resigned. 
Unexpectedly, after leaving the hospital, this little wish of mine came true! 
Just yesterday, with no shift scheduled, I went to Chang Shen Hospital in Zhongli to shadow Director Ta-Wei Su of vascular surgery. The patients came to Dr. Su’s special clinic that day, and he immediately made a preliminary assessment of each lesion with ultrasound in the consultation room; if the patient could wait, the problem could be handled directly in the operating room that same day.
I was very lucky: the whole day yesterday I saw balloon angioplasty used for dialysis access stenosis, percutaneous thrombectomy used for a graft with no flow sound, and how an arteriovenous fistula (AVF) is made and a dialysis graft (AVG) is placed. Only the placement of a neck dialysis catheter was missing; otherwise I would have collected everything!
What impressed me most was that after Dr. Su connected a graft to a patient’s artery and vein, I saw him repeatedly palpate the arterial and venous anastomoses to feel the strength of the flow. Because the thrill on the venous side felt slightly weaker, he did an angiogram for the patient right there in the operating room (it actually takes extra time, as one must take off the original sterile gown, put on a lead apron, then scrub again and put on a fresh sterile gown). Sure enough, a short segment of vein not far from the anastomosis was slightly narrowed; he treated it on the spot with balloon angioplasty, and on palpating again the flow was indeed much stronger. 
I silently thanked Dr. Su on the patient’s behalf, because his careful assessment and craftsman’s spirit of striving for perfection spared this grandmother the trouble of having to return to the operating room again.
I thank Dr. Su and his vascular surgery care team for taking every matter of dialysis patients’ vascular access seriously and handling them so thoroughly; it is truly a blessing for patients! 
Let us work together from now on to take good care of patients’ vessels! 
