Tracy Carlin, MS, RT(R)
Elizabeth Summons BSRN
Susan Slough RN
Crystal Randle RT(R)
Angelica Suaste, Access Center Coordinator
Otilia Monzon, Access Center Coordinator
The early detection and timely intervention of access dysfunction is critical to access preservation.
Dysfunction can occur in any type of access. One could experience infection, stenosis (a narrowing in an access that cause increased pressure and decreased blood flow), thrombosis (clotting) or an aneurysm (a bulging or “bump” in the access)
An angiogram is a picture of the inside of the fistula or graft using x-rays. A local anesthetic is used.
A small needle is inserted and dye is injected while x-ray pictures are observed to identify whether an additional procedure is needed.
An angioplasty is performed if a stenosis was observed on the angiogram. A local anesthetic and possible IV sedation are used. A small catheter with a balloon at the tip is inserted and inflated to stretch the narrowed area. The balloon is removed at the end of the procedure. Sometimes a stent (a metal piece of mesh) is needed to support the vessel walls to keep the access open. The stent will remain inside the fistula or graft and does not move.
A thrombectomy is the procedure performed to restore blood flow to a clotted access. A local anesthetic and IV sedation are usually used. The physician may use medications or devices to break up clots and to sweep and suction the clots away.
A catheter placement is the insertion of a tunneled cuffed hemodialysis catheter. A local anesthetic and possibly IV sedation are used. The catheter is placed in a vein in the neck (sometimes in the groin) to obtain access to the bloodstream. A tunnel is created under the skin and leads up to the point where the catheter exists the body.
A catheter exchange is performed to improve blood flow or when there is an infection present. A local anesthetic and possibly IV sedation are used. The cuff is loosened and a wire is advanced through the catheter. The old catheter is removed and a new one is placed over the wire.
A catheter removal is performed when the catheter is no longer needed. The catheter exist site area is numbed using a local anesthetic. Once the cuff is freed from the tissue, the catheter slides out of the tunnel and removal is complete.
Vessel mapping is performed prior to fistula or graft placement. This procedure measures and evaluates arteries and veins for successful vascular access creation. Testing may include an ultrasound and venogram (IV x-ray of veins). A venogram requires insertion of an IV and injection of a small amount of dye.
Early detection and timely resolution of access dysfunction are critical to access preservation. Timely resolution leads to fewer missed dialysis treatments and a lower frequency of hospitalization.
The most common dialysis access problem is the narrowing of the access or the blood vessel attached to it. This narrowing, called “stenosis,” can lead to clotting of the access. If this happens, dialysis treatments will not be effective and the access may eventually stop flowing.
The following procedures are performed in our centers in support of optimum dialysis access health:
Peripheral Arterial Disease
Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD is caused by narrowed and blocked arteries in critical regions of the body. PAD most commonly affects arteries in the legs.
Quick facts about PAD
The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.
Be aware that:
Added risks for PAD
Other factors can increase your chances for peripheral artery disease, including:
Symptoms and Diagnosis of PAD
The most common symptom of peripheral artery disease (PAD) in the lower extremities is a painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising.
The pain of PAD often goes away when you stop exercising, although this may take a few minutes. Working muscles need more blood flow. Resting muscles can get by with less.
If there’s a blood-flow blockage due to plaque buildup, the muscles won’t get enough blood during exercise to meet the needs. The “crampy” pain (called “intermittent claudication”), when caused by PAD, is the muscles’ way of warning the body that it isn’t receiving enough blood during exercise to meet the increased demand.
***Many people with PAD have no symptoms or mistake their symptoms for something else.
Chronic Venous Insufficiency (CVI) is a progressive medical condition that worsens over time and affects the veins and vessels in the leg that carry oxygen-poor blood back toward the heart.
If not treated, Chronic Venous Insufficiency can lead to spider veins, varicose veins, leg swelling, cramping and restless legs and non-healing wounds. The following minimally invasive treatment options are performed in a number of our centers for the management of CVI:
In addition to hemodialysis, there is a second type of dialysis available to patients called “peritoneal dialysis.” Instead of having a fistula, graft or central venous catheter, some people choose to use a peritoneal dialysis catheter, or “PD catheter” for their dialysis treatments. PD catheter placement is an outpatient procedure, and just one of many dialysis access procedures performed at many of our centers.
Our peritoneal catheter services include: