What is a “dialysis access”?
Dialysis access a surgically created connection between one of your arteries and veins. It must carry a lot of blood flow, so that when it is used for dialysis there will be a lot of blood that runs through the dialysis machine. This will clean most of your blood, since your kidneys cannot do that job.
There are two major types of dialysis access:
A Native Arteriovenous Fistula (AVF) is made from a direct connection between an artery and a vein. The vein is punctured or “cannulated” during dialysis.
An Arteriovenous Dialysis Graft (AVG) uses a piece of bypass graft material to connect the artery and vein. The graft is cannulated during dialysis.
What is a fistulogram?
Both AVFs and AVGs are prone to develop narrowing (stenosis) or dilation (aneurysm). These changes can cause your dialysis access to clot, bleed, or have other complications. These complications may cause loss of use of your dialysis access on either a temporary or permanent basis. If permanent, you will need a new dialysis access (another surgery). A fistulogram is a study with fluoroscopy (X-ray) guidance to evaluate your dialysis access to try and find out why there is a malfunction or complication with dialysis. If a problem is found (stenosis, clot), it can be fixed before permanently losing the AVF or
How is a fistulogram 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. If there are areas requiring intervention then they will be treated accordingly. If narrowing is found in a blood vessel, 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. If there is a small amount of clot (blockage) found in a vessel, an attempt will be made to try and break up the clot (thrombolysis) and/or remove the clot (thrombectomy). 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.
When dialysis access can be used?
In most patients, the dialysis access can be used right away. If we have any concerns WE WILL TELL YOU!
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. Then 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.
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.
It is normal to have bruising on the arm the 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.
Finally… You should be able to feel the blood flow (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.
If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
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. You may be given a sling for the first 24 hours. When your arm is working normally, remove the sling.
You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next 24 hours.
You may use over the counter medication such as Acetaminophen (Tylenol) for minor discomfort, unless you are restricted from taking these medications.
If you feel that Tylenol is not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.
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.
You can take a shower tonight.
The procedural site is sealed with skin glue.
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