Vascular Access / Dialysis
A vascular access is an entrance to your blood vessels that can be used for dialysis. Dialysis is a treatment used for kidney failure. Vascular access can be created in many ways, such as by:
Placing a thin, flexible tube (catheter) in a large vein, usually in your neck, chest, or groin.
Joining an artery to a vein under your skin to make a bigger blood vessel called a fistula.
Joining an artery to a vein under your skin using a soft tube called a graft.
A vascular access can become blocked or stop working correctly (malfunction).
What can cause my vascular 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 vascular 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 vascular access malfunctions?
If your vascular access malfunctions, your health care provider may order blood work, cultures, or an X-ray test to find out what went wrong. The X-ray test involves the injection of a dye (contrast) into the vascular access. The contrast shows up on the X-ray and lets your health care provider see if there is a blockage in the vascular access.
How is it treated?
Treatment varies depending on the cause of the malfunction:
If the vascular access is infected, you may be prescribed antibiotics to control the infection and a temporary catheter may be placed so you can resume dialysis..
If a clot is found in the vascular access, you may need a procedure called a “declot fistulogram” that will use blood thinning medicines to break down the clot and remove it.
If a blockage in the vascular access is due to some other cause, such as a kink in a graft, you may need a “fistulogram” with angioplasty (ballooning the narrowing site or kink). You may need surgery to unblock or replace the graft.
If there is a malfunction for any reason, you may have a hemodialysis catheter placed if your access cannot be immediately fixed.
These interventional radiology procedures are performed in the catheterization laboratory, also called “cath lab”. An entire team will be taking care of you during the procedure including 2 nurses, a radiography technologist and the physician. In the procedure room, the nurse will help you lay on an exam table. You will be connected to heart and blood pressure monitors. Moderate, also known as “twilight” sedation will be given to relax you. Your groin area may be shaved and washed with a special soap and covered with sterile sheets. Local anesthetic will be given to numb the procedure area and you may feel some burning as the medicine is given. The procedure time varies, but usually takes about 1 hour. Throughout the procedure, medication is given through your IV to keep you comfortable. Your oxygen saturation, blood pressure and pulse are checked closely during and after the procedure.
What you can expect after the procedure?
After the procedure you will go to the post surgical area at El Camino Hospital (unit 2B) for recovery. There your vital signs and procedural site will be monitored. In general, you will be there for about 1 hour after your procedure was completed to be sure you do not have any problems before you go home.
You will be able to eat and drink right after the procedure while you are in recovery. Your family members and/or friends will be brought to you in recovery soon after the procedure.
When you go home, we recommend that you take it slow for the rest of that day. You should not drive, operate heavy machinery, consume alcohol or make any major decisions until the following day after the procedure, if you received sedation.
What are the risks?
As with any interventional procedure, there is a small risk of bleeding at the catheter insertion site. Most of the time we use a small plug to avoid this problem and thankfully the overall risk is small. Fortunately, the risk of infection is very small also. You may receive antibiotics during the procedure, which helps prevent an infection. If the catheter gets infected the treatment involves removing the catheter and prescribing antibiotics.
There is a small chance of allergic reaction to the contrast material used to view your vessels with X-ray. There is also a risk for kidney damage, especially for patients with diabetes or pre-existing kidney disease. The effects from the contrast vary for every patient. Medicines and IV fluids are given to help prevent or relieve most of these side effects. Also, steps can be taken before the procedure to prevent allergic reactions to contrast and lessen the chance of kidney damage for those at risk.
How long does it take to recover?
Most patients should be able to return to their normal activities the day after the procedure.
We recommend no contact sports or extraneous activity for a period of approximately 1 week post-procedure to minimize the chance of bleeding.
When can my access be used again?
Your vascular/dialysis access can be used immediately unless told otherwise after your procedure.
What should I watch for?
You may be sore with mild bruising after the procedure. However, the pain should not be getting worse and should subside in 2-3 days. If you develop severe pain or if the pain is getting worse you should call us at (650)404-8445 and seek immediate medical attention.
Worsening of pain, redness, warmth or discharge at the site of the procedure may be signs of infection.
If you develop shortness of breath or chest tightness you should contact us at (650)404-8445 and go to the nearest emergency room for evaluation.
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.