Columbia Nephrology Associates

Clinical Services

Pre-Procedure Requirements:

Do not eat or drink anything for at least 6 hours before the procedure. All medications can be taken with small sips of water except any type of blood thinners or anti-platelet medication. Inform your dialysis nurse if you are taking any type of blood thinners. If you are on insulin, please hold until after the procedure. We will provide a snack after your procedure.
You must have someone drive you home after the procedure. Please bring your driver’s license and insurance card(s) with you.

Post-Procedure Instructions

If you received sedation, it is not safe for you to drive. This is why we require you to have a driver with you. Do not perform any activities until the following morning that would require you to be fully alert and coordinated. Do not sign any legal papers for 24 hours following your sedation. Resume your normal diet and medications.

FISTULAGRAMS (Imaging of Graft or Fistula)

Under X-ray, contrast (Dye) is injected through a needle puncture in the vascular access to determine if there are any stenotic areas (narrowing) within the fistula or graft, and/or any accessory veins or arteries. Reasons for this study could be related to the following:
Difficulty cannulating the access
Increased venous pressures 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, and pulsatile site
Steal Syndrome: hand below access cold, painful, or numb

After your procedure, check your access site for bleeding or swelling over the next 24 hours. If bleeding occurs, apply gentle pressure. If bleeding does not stop within 15-20 minutes, please call 252-9907. Keep extremity elevated over the next 24 hours. Do not lie on affected extremity.

ANGIOPLASTY (Ballooning of narrowed area)

If the Fistulagram confirms a stenosis (narrowing), the physician will insert an angioplasty balloon in to the narrowed blood vessel. The balloon is inflated to dilate the vessel to improve blood flow. The balloon will then be removed. Angioplasty will improve dialysis, and could help prevent the fistula and graft from clotting.

THROMBOLYSIS (Declot of graft or fistula)

Fistulas and grafts can become clotted for various reasons. There will be an absence of a bruit and thrill within the access. Grafts have an increased incidence of clotting over fistulas. Once a positive determination has been made by the dialysis nurse or physician, the procedure will be scheduled. It is necessary to have the procedure scheduled as soon as possible. A special catheter (embolectomy catheter) will be introduced through a needle puncture in the fistula or graft, and clots will be removed. If the reason for the clotting is due to a stenosis, an angioplasty will be done during the declot procedure.

STENT PLACEMENTS

Sometimes stenotic (narrowed) areas are considered elastic. This means that the lesion is like a rubber band and after it is opened with a balloon, it closes back down once the balloon is removed. If this is the case, a stent may be needed. Stents are expandable tubes made of covered metal mesh. The angioplasty procedure opens the vessel, and stents are placed and expanded to fit the size, shape and bend of the vessel. The stent remains in the vessel after the procedure to help keep the vessel open. Over time, the vessel wall heals around the stent.

TUNNELED CATHETER PLACEMENTS AND/OR EXCHANGES

Many times a tunneled catheter will be placed and can be used immediately for dialysis while a fistula or graft is maturing. Catheters are usually placed in the neck around the area of the collar bone. If the catheter cannot be placed in the neck due to blockages in your veins, it will then be placed in the thigh. Catheters have more complications than fistulas and grafts. Sometimes, catheters must be removed or exchanged. Some reasons for this are:

Infection

Clotting in the catheter tip

Exposed Cuff (the cuff that adheres the catheter to the surrounding tissue becomes exposed to the outside)

Damage (puncture or crack) in the catheter

Recirculation of blood while on dialysis

After your procedure, check your access site for bleeding or swelling over the next 24 hours. If bleeding occurs, apply gentle pressure. If bleeding does not stop within 15-20 minutes, please call 252-9907. Some pain is to be expected at the placement or removal site. Once the effect of anesthesia wears off, call the office if your pain is not responsive to Tylenol or other over the counter pain medications.

TUNNELED CATHETER REMOVALS

Removal of the catheter will be scheduled once the fistula or graft has been successfully cannulated by the dialysis staff. The area on your neck will be prepped with a sterile solution. The doctor will then inject a numbing medication and the physician will remove the catheter.

Note: Inform your nurse if you are taking any type of blood thinners.

After your procedure, check your access site for bleeding or swelling over the next 24 hours. If bleeding occurs, apply gentle pressure. If bleeding does not stop within 15-20 minutes, please call 252-9907. Some pain is to be expected at the placement or removal site. Once the effect of anesthesia wears off, call the office if your pain is not responsive to Tylenol or other over the counter pain medications.

TUNNELED CATHETER HUB REPAIRS

Occasionally, a clamp on the catheter will break or an area on the catheter gets damaged. This hub can be repaired in a few minutes at the Access Center.

TEMPORARY DIALYSIS CATHETER PLACEMENTS

A Temporary Short Term Catheter will be placed if it is determined that your access is not functional, and emergent dialysis is needed for fluid overload or increased potassium levels in the blood. A Temporary Catheter will be placed, usually in the groin area (femoral vein) so dialysis can be done immediately. After dialysis, the physician will remove the catheter, and the patient will be scheduled for a procedure to correct the non-functioning access. The procedure may be done the same day, or the patient may return the next day for the procedure.

Other Services

Administration of IV iron to CKD patients who have not started dialysis.

Administration of Aranesp to CKD patients who have not started dialysis.