We strive at HVAC to make your experience as smooth, friendly, and safe as possible. After your arrival and signature for some paperwork, your nurse and doctor will perform an intake history and physical to make sure we are up to date on your health history. Once the procedure room is ready, you will be taken into a state-of- the-art room with the latest technology and equipment available. Your arm will be prepped and draped in a sterile manner, and local lidocaine will be given by the physician for local anesthesia. Xray pictures of the access will be performed, and if any intervention will be performed, you will be given intravenous sedation. After the procedure, you will be moved to the recovery area where you will have time to wake up and eat.

Time varies due to the type and complexity of the procedure. Some procedures may take 5 minutes while others may last up to an hour. It is important to budget approximately 2 to 2.5 hours from arrival to discharge. This ensures we have enough time to dedicate our full attention to your safety and optimal outcome.

We strive to make the procedure as comfortable and painless as possible. As with all interventions, some pressure and discomfort may be experienced during or after the procedure. Your doctor will be aggressive in addressing your pain. Most patient have a very enjoyable experience with no intra-procedure or post-procedure discomfort.

No. It is important to have other means of transportation as you will be given IV sedation. You should avoid making any important decisions or operating machinery for 24 hours after the procedure. Please contact our office if you have no other means of transportation.

Pre and Post Instructions

Often, patients can have significant abnormalities in their access but not notice any problems. Your healthcare team at the dialysis unit will examine your access to look for any signs or symptoms that may be concerning. It is important to have routine surveillance of the access, as early intervention can prevent more serious issues. Maintaining a healthy access is key to getting optimal dialysis.

You are your own best advocate for your healthcare. Feeling and listening to your fistula and noticing any changes in pressure, flow, or sound can be an early sign of abnormalities. Additionally, cleaning your arm appropriately as prescribed by you dialysis unit to prevent infection and avoiding other needle sticks or blood pressure exams of the access arm is important. Prevention and routine follow-ups will help prolong the life of your access.

Following a good dialysis schedule and renal diet as prescribed by your nephrologist and dietician is critical to maintaining a healthy access. Factors such as high phosphorus levels, shortened or missed dialysis sessions, and elevated PTH levels can all contribute to calcification and failure of your access. Investing in the correct dietary and lifestyle priorities can have big benefits in the health of your fistula or graft. Monitoring of fluid intake and restricting potassium intake can help prevent hospitalizations and other serious complications.

Dialysis Access

A graft is a synthetic tube that is used to connect an artery and vein when the patient’s own native vessels may be too small to support a fistula.  The tube is usually made of PTFE, but other plastics and even bovine vessels may be used.  A graft may be cannulated 3-4 weeks after placement in most cases.

A fistula is created by directly connecting a native artery and vein. Fistulas can be placed in the upper or lower arms, and they generally take a couple of months to mature before they can be used.  Fistulas, when mature, typically last longer and clot less than grafts.

Catheters can malfunction for several reasons, including kinking in the tunnel, clots, and fibrin build up around the tip of the catheter. The body recognizes the catheter as a foreign material, and inflammation can contribute to these issues. Your doctor will help confirm the correct placement and tunnel location, and any fibrin or clots will be removed prior to placement of a new catheter. Some people, despite aggressive management, will need their catheter exchanged every couple of months.

Small or deep vessels, decreased flow, accessory veins, focal narrowing, and certain other anatomical abnormalities can contribute to difficult cannulation of an access. The use of both ultrasound and Xray imaging will help your doctor correct these issues to allow smoother cannulation by the dialysis unit. It is important to follow a good diet and hand exercises (if prescribed) to allow optimal health of the fistula or graft.

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