Dialysis | Vascular Access

Dialysis catheter placements are done in a special procedure room, using X-rays and contrast (dye) to help guide the catheter (a small tube) into a large blood vessel (vein) that runs directly to the heart. The chest or neck is often the preferred area for placement. This catheter is a special tube that has two channels and is used for dialysis.

An angioplasty is a procedure that opens up blocked or narrowed fistulas or grafts without surgery. The doctor uses X-rays and contrast (dye) to help guide a catheter (a small tube) through the skin into a blood vessel to the exact location of the blocked or narrowed fistula or graft.

There is a balloon on the end of this small catheter. When the balloon is placed in the area of the blockage or narrowing, the balloon is filled and emptied a number of times, which opens the narrowing. This helps increase the flow of blood through that area, thus maintaining the life of your graft or fistula.

Thrombolysis is a procedure to remove a blood clot (thrombus) from your fistula or graft. It is performed in a special procedure room using X-rays and contrast (dye) to help the doctor find the exact location of the blood clot.

The doctor performing this procedure will determine the best way to remove the clot. Thrombolysis by any of these methods helps prolong the life of your graft or fistula, and may prevent the need for surgery.

After Your Dialysis Catheter Insertion 

You may have received intravenous medicine that causes weakness and sleepiness. Rest and limit your activity for 24 hours. Have someone to help you at home. Do not drive, use machinery, or make any important decisions for 24 hours after taking pain medication.

• You may resume your previous diet and medications.
• Apply ice to site 20 minutes per hour while awake.
• Do not lie flat. Sleep with your head up on two pillows for 24 hours.
• You may restart Coumadin if directed by your provider.
• You may take 1-2 acetaminophen tablets every 4-6 hours for discomfort.
• Make sure the catheter caps are in place and the clamps are closed.
• Try not to get the catheter dressing wet. It needs to be kept as dry as possible.
• Do not remove the dressing. If the catheter gets wet, call the VAC. No showers or baths until cleared by the dialysis unit.
• Wear clothing to dialysis that allows the staff to easily change the catheter dressing. A shirt or blouse that buttons in the front is best.
• Call the VAC if you experience: bleeding or drainage from the catheter site, pain or swelling around the site, fever or chills.
• Do NOT let anyone but the dialysis staff use the catheter.

Emergency Situations: If bleeding occurs from the ends of your catheter, check the clamps--if they are open, close them. If the bleeding continues, pinch the tubing to stop the bleeding and call 911. If your catheter comes out, IMMEDIATELY apply pressure with a gauze or clean towel. Sit down, limit movement, and call for help.

After Your Fistulagram

You may have received intravenous medicine that causes weakness and sleepiness. Rest and limit your activity for 24 hours. Have someone to help you at home. Do not drive, use machinery, or make any important decisions for 24 hours or while taking pain medication.

• You may resume your previous diet, medications and activity.
• Your provider will tell you when to return to have your sutures removed.
• If bleeding from your fistula should occur, apply pressure to the site and hold until the bleeding stops.
• If bleeding does not stop after 15 minutes, continue to apply pressure and call the VAC.
• You may restart Coumadin if directed by your provider.
• Call the VAC if you have fever, chills, pain, or redness over the fistula, or if your fingers or hand become cold, painful, or blue.
• You may take 1-2 acetaminophen tablets every 4-6 hours for discomfort.
• Do NOT wear anything tight around the fistula arm, this includes clothing and jewelry.
• Do NOT hang purses or shopping bags from the fistula arm.
• Do NOT allow anyone to take your blood pressure on the fistula arm.
• Do NOT allow anyone except dialysis personnel to stick needles of any kind in the fistula arm.
• Feel for the thrill every day. The thrill is the vibration you feel over the fistula that means the blood is flowing through it. If you cannot feel the thrill, call the VAC or the dialysis unit.