Dialysis Fistulagram

Using X-ray imaging and contrast material (often called “dye”) your doctor will insert a catheter into your fistula. This will allow your doctor to see how blood is flowing within the graft and check for blockages or blood clots.

When you arrive for your procedure a nurse will greet you and let the team know you’ve arrived. You will be brought into an exam room and asked to change into a gown. Your doctor will greet you, explain the procedure and answer any questions you may have.

You will lie on an exam table for the procedure. The technologist or nurse will connect monitors for your heart rate, blood pressure, and pulse, and an intravenous (IV) line will be inserted into a vein in your hand or arm. This will be used to give you sedatives during the procedure.

The technologist will shave, sterilize, and cover the area of your body where a catheter will be inserted with a surgical drape. The area will then be numbed using a local anesthetic. You may feel a tiny pinch when the anesthesia is administered. The radiologist will make a very small nick, and you may feel some pressure as the catheter is inserted, but you won’t feel any serious discomfort. Once the catheter is in place and the dye has been injected, X-ray images will be taken to evaluate the fistula. If a blockage is detected the doctor may inject medicine to resolve the clot.

Once the procedure is complete, the catheter will be removed. Your IV line will be removed as well. Your doctor will apply pressure to stop any bleeding and cover the area with a bandage. You will not need stitches. This procedure usually takes anywhere between 1 to 2 hours but may vary depending on whether blockages or clots are discovered in your graft.

Afterward you will be taken to a recovery area to rest. Once you have recovered and feel ready you may go home. You may feel some pain following the procedure and this can usually be treated with over-the-counter pain medications. You should discuss this with your physician.

Your doctor will discuss any limitations you may have to your daily activities. Most patients can resume their regular activities within a day.

You should call your doctor if you have any bleeding, fever, swelling or drainage at the catheter insertion site.

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or — as you’re doing now — educate yourself about the procedure.

Some other things to keep in mind in planning for this procedure include:

• You should plan to have someone accompany you to the procedure or pick you up afterward as you will not be able to drive after being sedated.
• Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin or warfarin) for a time before the procedure.
• The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a nurse from your doctor’s office will call you. The nurse will give you any additional instructions, and will ask if you have any questions.
• When you arrive, make sure the nurse or doctor knows about any allergies you may have, especially allergies to contrast dye and to local anesthetics, such as lidocaine. If there’s any chance you may be pregnant, tell your physician.

On the day of your procedure you should:

• Wear comfortable, loose-fitting clothes
• Wear comfortable shoes
• Avoid bringing jewelry or valuables

The benefits of a fistulagram procedure may include:

• Safe, accurate evaluation of dialysis fistula graft function which may lead to better dialysis outcomes
• Minimally invasive procedure that does not require surgery. Most patients can resume normal activities within a day

Some risks that you should be aware of include:

• As with any procedure there is a slight risk of infection. This is rare.
• Slight risk of allergic reaction to the contrast dye used during the procedure.
• As with any procedure that involves a catheter placed inside a blood vessel, there is potential for damage to the blood vessel, bruising or bleeding at the puncture site.
• There is a slight risk that bleeding will occur in another part of your body if anticoagulant medications are used.

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.