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What is a vascular dialysis access?

A dialysis access is a special type of blood vessel that can be used to do the dialysis. It is made from a connection between one of the arteries to one of the veins. 

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There are two major types of dialysis access:

  1. Native Arteriovenous Fistula (AVF): A connection of an artery to a vein.

  2. Arteriovenous Graft (AVG): A special tube connected between an artery and vein.

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What can cause my dialysis access to malfunction?

  • A blood clot inside a part of the fistula, graft, or catheter. A blood clot can completely or partially block the flow of blood.

  • Infection of the access

  • A kink in the graft or catheter.

  • A collection of blood (hematoma or bruise) next to the graft or catheter that pushes against it, blocking the flow of blood.

What are signs and symptoms of dialysis access malfunction?

  • A change in the vibration or pulse (thrill) of your fistula or graft (weaker or more pulsatile).

  • Absent thrill of your fistula or graft.

  • New or unusual swelling of the area around the access.

  • Frequent unsuccessful puncturing (cannulation) of your access by the dialysis team.

  • The flow of blood through the fistula, graft, or catheter being too slow for effective dialysis.

  • Prolonged bleeding after dialysis that cannot be easily controlled

  • Signs of infection such as pain, swelling, redness, red streaks, numbness, and blood or pus coming from or around the access.

What happens if my dialysis access is clotted?

If your dialysis access is clotted, it means that you were not able, and will not be able to, undergo hemodialysis.  You will need a procedure to investigate and treat the cause of your access to clot called an arteriovenous declot procedure.

How is a declot done?

Your procedure will be done at El Camino Hospital where you may be set up with an IV to allow access for moderate, also known as “twilight” sedation.  You will then be taken to the procedure room where you will have a team of two nurses, a radiology technician and your interventional radiologist.  You will be connected to heart, blood pressure and oxygen monitors during the entire procedure.  IV medication will be administered to make you comfortable (moderate sedation).  Then your interventional radiologist will administer numbing medication (local anesthetic) to the procedure site.  Using fluoroscopy guidance (X-ray) a catheter will be inserted through a blood vessel.  A small amount of dye may be used to “map” out the blood vessels and assess for any abnormal areas of narrowing or blockage.  This is the fistulogram part of the procedure.  Once the areas that are occluded are identified then a device will be used to try and extract the clot (thombectomy) and/or use medication to break up the clot (thrombolysis).  If narrowing is found in a blood vessel (common cause for a clot to form), a balloon would be inflated at that site (angioplasty), widening up narrowing and improving blood flow.  Sometimes after ballooning there will be recoil of the narrowing and a stent may be needed in order to keep the narrowing from reoccurring.  The procedure usually takes about 30-60 minutes.

What can you expect after the procedure?

You will recover after your procedure for about 1 hour where your procedure site, heart rate, blood pressure, and oxygen saturation will be monitored.  Your family will be able to see you soon after the procedure in the post-operative area.  If you are scheduled for dialysis that day, it may be arranged to be done at the hospital per your Nephrologist, otherwise you should be able to use your dialysis access normally at your next scheduled dialysis.   Upon returning home you may have some bruising or tenderness at the procedure site, which should only last for a few days.

Care at the procedure site:

We sometimes place a small white plug at the puncture site called a “Tip-Stop.” You should leave that in place until your next dialysis or 24 hour. Sometimes we apply a small dissolvable stitch at the site which should dissolve in the next few days.

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After 24 hours you should be able to get the declot puncture sites wet or shower.

When dialysis access can be used?

In most patients, the dialysis access can be used right away.  We will tell you if you cannot use it.

What should I watch for?

You may be sore after the procedure, but this should not get worse and should subside in 2-3 days.  During this time you may take Acetaminophen (Tylenol) if necessary.  You should avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil, Motrin) or Naproxen (Aleve) as they are not good for your kidneys.  If you develop sudden pain or new swelling, call our office 650.404.8445 or go to the emergency room if after 5pm or on the weekend.  

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It is normal to have bruising on the arm the fistulogram procedure was done on.  The bruise may become darker over the next few days.  This is a normal response.  The bruise should not become painful or swollen.

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Finally… You should be able to feel the blood flow (a vibration called a “THRILL”) at your fistula. If that stops you should call your Interventional Radiologist at 650.404.8445.

How long can the dialysis access stay in place? 

The dialysis access can stay in place as long as it is working. We hope for your whole life or until you get a kidney transplant.

What if the site starts bleeding? What should I do?

DON’T PANIC !!!! Take a deep breath. Any bleeding can be controlled by just putting a finger in the site of bleeding. It will certainly stop. Hold pressure for about 15 minutes and almost always it will stop. Once the bleeding is controlled, you should call your Interventional Radiologist at 650.404.8445. 

General Instructions:

Sedation

  • If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.

Regional Block

  • If you had a regional block, which means your entire arm was anesthetized with local anesthetic, you may have difficulty in moving your arm for 24 hours. That is normal, so don’t worry. It is temporary.

Activity

  • You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.

  • No exercising, lifting have objects or strenuous activity for the next 24h.

Pain Management

  • You may use over the counter medication such as acetaminophen (Tylenol) for minor discomfort, unless you are restricted from taking this medication.

  • If you feel that Tylenol is not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.

Diet

  • You can resume your normal diet recommended by your nephrologist. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.

Shower

  • You can take a shower tonight. 

  • The access site is sealed with skin glue that will fall off in 1-2 weeks.

When should you call your physician?

  • Fever or chills > 101.5 F

  • Worsening of redness or worsening of pain in the procedure area

  • New arm swelling

  • Problems when using the dialysis access

  • If the dialysis access gets clogged again!

You can always reach your Interventional radiologist at (650) 404-8446

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