Fistulagram

As a hemodialysis patient currently using an AV fistula or AV graft, you may occasionally encounter problems during dialysis. Narrowing within your AV fistula/graft may lead to difficulty with IV placement during dialysis, alarming of the dialysis machine, poor clearance, or longer bleeding time at the end of dialysis. Additionally, ultrasounds of your AV fistula/graft may identify a narrowing before they are noticed at the dialysis center. If so, your provider may recommend a fistulagram to treat the narrowed area.

You will be given an exact time to arrive for your fistulagram a day or two before your procedure. You can eat a regular diet on the day of the procedure. You can continue all your medications, including blood thinners. In special scenarios, the physician may ask for you to stop eating at midnight before your procedure, and to stop your blood thinners.

You will be given IV contrast during your procedure to help show your blood vessels under the X-ray machine. Please alert your healthcare provider if you have ever had an allergic reaction to IV contrast.

The fistulagram and possible angioplasty can be repeated as often as needed to help keep your graft or fistula open. This is a safe, commonly performed procedure.

You will be brought into a procedure room and asked to lie on a flat x-ray table. Heart monitors and blood pressure cuffs will be applied, and a sterile drape will cover you. When the procedure begins, the physician will numb the skin and insert a small catheter into the AV fistula/graft. IV dye will be injected through the catheter to show the fistula/graft under the x-ray machine. The physician will interpret the images and determine if an intervention is needed.

If an intervention is needed, the physician will use various tools to remove blood clots or blockages within the AV fistula/graft. They may use balloons to dilate any narrowing, or place a stent. The catheter will be removed once the procedure is complete.

• The physician may not be able to fix problems he/she finds within your AV fistula/graft.
• There is a risk of bleeding or infection.
• The fistula/graft may be damaged.
• IV contrast may cause kidney failure or an allergic reaction.

These procedures are typically performed as an outpatient procedure and last about an hour. Afterwards you will rest in a recovery area for a while before you are sent home or back to dialysis.

Most patients can resume normal activities the next day; however, you should avoid lifting heavy objects and strenuous exercise for at least 24 hours.

If you notice any signs of pain or bleeding where the catheter was inserted, you should lie down, apply pressure to the site, and call your physician.