January 18th, 2019
DNA has Vascular Access Centers that perform specialized interventional procedures to dialysis patients experiencing problems with their vascular access. While not every dialysis patient is a candidate for outpatient intervention, early treatment of problems can reduce major complications and minimize hospitalization related to access care.
An Interventional Procedure may be needed if an Angiogram or Fistulogram study indicates there is:
- Difficulty cannulating the access
- Increased venous pressure on dialysis
- Excessive negative arterial pressure on dialysis
- Prolonged bleeding after dialysis
- Inability to achieve adequate blood flow on dialysis
- Decrease in thrill and bruit
- Steal syndrome – hand below access is cold, painful or numb
Catheter Placement or Exchange may be performed if there is:
- Clotting in the catheter tip
- Exposed cuff (the cuff that adheres the catheter to surrounding tissue)
- Damage (puncture or crack in the catheter)
- Recirculation of blood while on dialysis
Interventional Procedures Performed include:
Declot / Thrombectomy – Medication is placed into the patient’s graft or fistula to dissolve clots that have formed. Clots may also be extracted from the site by a physician.
Angiogram / Fistulogram – Contrast dye is injected through the graft or fistula to determine the cause of a blood flow problem. If stenosis or narrowing is found, this procedure may require an angioplasty and/or stent.
Angioplasty – A balloon catheter is inserted through the graft or fistula and inflated to dilate or open the narrowing.
Stent Placement – Placement of a metallic stent to hold open a blood vessel. Performed after an angioplasty.
Tunneled Dialysis Catheter Insertion – Catheter is placed in one of the veins in the neck or leg.
Tunneled Catheter Exchange – Replacement of a catheter for a new or different type. This may also involve an angioplasty if the catheter has not been functioning correctly.
Tunneled Dialysis Catheter Removal – Removal of catheter when no longer needed.
Temporary Catheter Insertion – This catheter is usually placed in the femoral vein and is removed after dialysis.
Vein Mapping – IV dye is used to view veins in the arms and chest to help plan the placement of a new graft or fistula.
Paracentesis – Drainage of fluid that accumulates in the abdomen.
Instructions are given by either your dialysis center or one of our staff members.
In general, there are no restrictions regarding medications prior to these procedures EXCEPT for blood thinners and anti-platelet medications. Be sure to ask your nephrologist if it is safe to discontinue taking blood thinners and anti-platelet medications, and if there are any other specific instructions regarding your medications.
Notify our center prior to your procedure if you have a severe allergy to latex and/or contract dye.
When having a declot procedure, catheter placement, angiogram or angioplasty do NOT eat or drink after midnight the night before your procedure. For other procedures, you may eat a light meal in the morning, particularly if you are diabetic.
Conscious sedation is used when having a declot procedure, catheter placement, angiogram or angioplasty. A local anesthetic is used for all other procedures.
Patient education is provided and a timely report is sent to your doctor and dialysis facility.