Contrast (Dye) is injected through a needle puncture in the vascular access to determine if there are any stenotic areas (narrowing) within the fistula or graft, and/or any accessory veins or arteries. Reasons for this study could be related to the following.
1. Difficulty cannulating the access
2. Increased venous pressures on dialysis
3. Excessive negative arterial pressure on dialysis
4. Polonged bleeding after dialysis
5. Inability to achieve adequate blood flow on dialysis
6. Decrease in thrill and bruit, and pulsatile site
7. Steal Syndrome: hand below access cold, painful, or numb
If the Fistulagram confirms a stenosis, the physician will insert an angioplasty balloon in to the stenotic blood vessel. The balloon is inflated to dilate the vessel to improve blood flow. Angioplasty will improve dialysis, and could help prevent the fistula and graft from clotting.
Fistulas and grafts can become clotted for various reasons. There will be an absence of a bruit and thrill within the access. Grafts have an increased incidence of clotting over fistulas. Once a positive determination has been made by the dialysis nurse or physician the procedure will be scheduled. A special catheter (embolectomy catheter) will be introduced through a needle puncture in the fistula or graft, and clots will be removed. If the reason for the clotting is due to a stenosis, an angioplasty will be done during the De-clot procedure.
Tunneled Cuffed Catheter Placement or Exchange
Many times a tunneled cuffed catheter will be placed and can be used immediately for dialysis while a fistula and graft are maturing. Catheters are usually placed in the neck around the area of the collar bone. Catheters have the more complications than fistulas and grafts. Sometimes, catheters must to be removed or exchanged. Some reasons for this are.
- Clotting in the catheter tip
- Exposed Cuff (he cuff that adheres the catheter to the surrounding tissue becomes exposed to the outside)
- Damage (puncture or crack) in the catheter
- Recirculation of blood while on dialysis
Nothing by mouth for at least 6hour before the procedure.
All medications can be taken with small sips of water except any type of blood thinners/anti platlet medication. Check with you doctor and dialysis nurse to be sure it is safe for you to hold these medications.
Take ½ of the usual amount NPH Insulin
Inform your nurse and the DAG office if you are taking any type of blood thinners
You must have someone drive you home after the procedure
Bring your insurance card(s) with you
Tunneled Cuffed Catheter Removals
Removal of the catheter will be scheduled once the fistula or graft has been successfully cannulated by the dialysis staff. The area on your neck will be injected with a numbing medication, and the physician will remove the catheter.
Note: Inform your nurse and the DAG office if you are taking any type of blood thinners
Tunneled Cuffed Catheters Repairs
Occasionally a clamp on the catheter will break, or an area on the catheter that is damaged can be repaired in a few minutes at the Access Center.
Temporary Dialysis Catheter Placement
A Temporary Short Term Catheter will be placed if it is determined that your access is not functional, and emergent dialysis is needed for fluid overload or increased potassium levels in the blood. A Temporary Catheter will be placed, usually in the groin area (femoral vein) so dialysis can be done immediately. After dialysis, the physician will remove the catheter, and the patient will be scheduled for a procedure to correct the non-functioning access. The procedure may be done the same day, or the patient may return the next day for the procedure.
Administration of IV iron to CKD patients who have not started dialysis.
Bring your insurance card(s) with you for all services