Dialysis Management Santa Fe (DMSF) provides hemodialysis access management, among other services, to patients with chronic kidney disease. This includes nursing care as well as connecting patients with health providers such as surgeons and nephrologists who can help them maintain good access and prevent complications from developing. For more information about DMSF’s dialysis access management services, contact us today at (505) 418-5925.
Introduction
The U.S. Renal Data System reports there are more than 250,000 patients in hospitals and skilled nursing facilities with an arteriovenous (AV) fistula for hemodialysis. Recent studies, including a study done in which Urology Associates was involved, have shown that many of these AV fistulas can be maintained at home using one or two dialysis treatments per week.
Imaging studies
The imaging study, also called a fistulogram, is done by an interventional radiologist. The radiologist passes a small flexible catheter (thin plastic tube) into your vein from an incision in your arm. The catheter’s tip has a special X-ray detector on its end that records any problems that can be seen on the X-ray.Dialysis Management Santa Fe
Radioactive scan
After a patient has his or her fistula and vein preparation, a radioactive scan will be performed by a nuclear medicine specialist. A radioactive isotope called 99Tcm will be injected into an arm vein, which will then slowly travel throughout your body. A scanner then picks up on radioactivity from that isotope and displays it on a screen as dark areas in various parts of your body.
CT Scan
Patients on peritoneal dialysis or hemodialysis have a fistula, an abnormal connection between two hollow organs in their bodies that allows for long-term use. A fistula is usually made surgically during a procedure called vascular access creation (VAC), or vascular access surgery.
Peripheral Arteriogram
Peripheral arteriography (sometimes referred to as a fistulogram) may be performed in patients with a dialysis fistula to evaluate for stenosis of their arteriovenous access. This procedure involves injecting dye into an artery in one extremity and imaging that artery using angiography. The use of a CT scanner permits the evaluation of an entire extremity, not just one specific vessel.
Arteriovenous Fistula (AFV) creation
There are two stages of AFV creation. The first stage, or angio-phase, involves creating a fistula using injections of materials such as papaverine and tetracycline through an artery and directly into an intended vein to stimulate growth. Because such procedures may result in serious injury or even death if performed incorrectly, these are usually only performed by vascular surgeons working in collaboration with a hemodialysis nurse who can monitor for problems during dialysis sessions.
Extra-Dialysis Stem Therapy (EDST) access devices
After a patient is fitted with a dialysis catheter, there are three possible sites from which extracorporeal treatment (dialyzes) can occur. These sites are called access locations, and they consist of an arteriovenous (AV) fistula or graft, an AV-tunneled catheter, or an extra-peritoneal (EP) catheter. A fistula has one end in a major vein and another end that ends in an artery to bypass surgery.
Potential complications of catheters
A catheter is an essential part of dialysis, allowing access to a patient’s bloodstream. While most patients find great relief in having 24/7 access to their bloodstream, catheters can also introduce complications. Typically a urologist or radiologist will remove and replace a catheter when necessary. However, there are two common types of complications with catheters: local infections and occlusions.
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