Dialysis is an important treatment for those with renal failure. The treatment runs blood through a machine to filter out waste and then returns it to the body. It is an intensive process that requires a tube inserted through a catheter in the vein or through an access graft. Coastal Vascular Center offers Dialysis Access Management.
The health of the veins is essential to the success of dialysis treatment. Blockages and other issues can make it harder for the catheter to get access. Dialysis access management could solve these problems or to work around them.
Here are some of the things that dialysis access management can do. This can help you understand if it’s right for you:
Vein Mapping
We use the latest in vein mapping technology to evaluate and determine the best access points for catheters and other procedures. To start, your doctor needs to know where the best places will be to gain access. Vein mapping determines the length and diameter of your veins. It also determines your health and suitability for catheter access. The procedure is performed with contrast dye to provide an image of the veins.
Vein mapping happens on those who have issues with their veins, such as venous disease, a history of blockages, or some other health condition. Seniors may also need the procedure since their veins may have become weakened or developed other problems.
Types Of Access Sites
Dialysis Grafts and Fistulas
A dialysis graft is created surgically in the arm or groin by connecting an artery to a vein with a tube made of woven plastic. After a month, the graft can be accessed with two needles at dialysis. While the graft is healing, most patients will need a catheter to receive dialysis. Grafts have lower infection rates than catheters, especially in the last two to three years before clotting off.
A dialysis fistula is surgically inserted in the arm by connecting an artery directly to a vein without the use of any plastic graft material. The vein near the connection to the artery will enlarge over a month before it becomes big enough to access with needles at dialysis. In some cases, the vein does not enlarge on its own. In this case an angioplasty procedure occurs. Although fistulas are more difficult to create, they can last up to 10 years. For this reason, a dialysis fistula is preferred over a dialysis graft or tunneled dialysis catheter.
Dialysis access management may salvage sites that were historically abandoned, prolong the effective life of the access sites, save money, and prevent complications.
Fistulogram
A fistulogram could be used when a dialysis fistula or graft cannot supply the dialysis machine with a high enough flow rate to clean the blood. In this procedure, an IV contrast injected through the graft identifies areas where the blood vessel narrows. Once found, a small balloon placed into the fistula or graft. This ballon expands to widen the blood vessel. Angioplasty it what this procedure is commonly called. If angioplasty does not improve the narrowing, a metallic stent could be inserted.
Treatment for Blockages and Clots
When there are blockages or clots in your veins, the catheter cannot get through easily. A thrombectomy or thrombolysis can remove the clot. In some cases, medication may dissolve the clot, and then a stent may keep the access point open.
Angioplasty can open up a blocked vein. A balloon is inserted to open the vein, and in some cases, a metal stent to keep the vein open. Stenting can also improve blood flow. A fistula salvage involves performing a series of angioplasties and stents to widen an immature vessel.
De-Clot Procedure
When a fistula or graft becomes completely clotted off, a de-clot procedure can open them up. In this procedure the contrast inserted into the clotted graft helps to see the extent of the clot formation. Then several technologies can help remove the clot from the clotted graft or fistula. Once the clot is removed, there is usually a narrowing identified that caused the access to clot. This narrowing is usually treated with angioplasty or stenting. If a fistula or graft clots off repeatedly in a short time, a dialysis catheter will need to be surgically placed to create a new access point.
Catheter Placement, Removal, and Repositioning
Dialysis Access Management Treatment starts with identifying the right placement for the catheter. However, if you have already had a catheter installed and are having problems with it, or are not getting the results you need from treatment, you can have the catheter removed and repositioned. Catheters can be placed in a vein in the chest, in the peritoneum, or in a fistula.
What to Expect After Dialysis Maintenance Procedures
After the procedure, you will be observed to make sure the medications have worn off.
In some cases, the procedure site will need stitches. The stitches are removed before you leave the hospital. Most central venous catheters are inserted with image guidance. Catheters are not ideal for long-term dialysis because of the risk for infection and blockage of the vein.
Dialysis access management also plays an important role in the maintenance of an established dialysis circuit by treating narrowed segments with angioplasty balloons and stents, thereby extending the longevity of the access to dialysis. For clotted access, your doctors may restore blood flow through the circuit via a de-clot procedure. Call us at 281-949-6020 to discuss your symptoms with one of our specialists and learn more about what treatment options are right for you.