- June 15, 2021
- Posted by: cmcdonald
- Categories: Dialysis Access Management Video, Video Library
Q: What to expect with Dialysis Access Management
A: When a patient presents for evaluation of the access at an affiliated American Endovascular center, a complete history and physical exam is performed of the patient’s access. Other questions are asked about the patient’s overall health. Once determined that the procedure can be performed safely as an outpatient, the patient is brought into the operating room. The arm is cleaned in a sterile fashion and the skin is anesthetized with Lidocaine. Lidocaine can cause a pinch and burn for a couple of seconds, but that then numbs the skin to allow for the angiocath, a small IV, to be introduced into the access.
Pictures are then taken using fluoroscopy, which is a live X-ray. We inject contrast dye into the access, which flows with the blood. It will show the areas of narrowing, tortuosity, and sometimes thrombus if it’s present. Once the decision has been made to perform angioplasty or stent placement for that patient, they will be given medication. The medications we typically use are Fentanyl and Versed. Fentanyl is a narcotic which helps with pain, and Versed is a benzodiazepine, which helps to relax the patient.
The patient will not be fully sedated because the procedure can be performed relatively quickly. We would like to have the patient retain complete control over their breathing and which also ensures that the blood pressure does not drop. Typical procedures for maintenance, such as those requiring angioplasty or stent placement, can take approximately 15-30 minutes. More complicated procedures, such as a thrombectomy or a maturation of a fistula or a graft, may take a little longer – perhaps 30 minutes to one hour. After the procedure, the patient will be brought to the post-operative area, where they will be monitored for complications and to ensure that they are able to get up and walk out of the office on their own.
More videos from the interview with Dr. Spinowitz of the Queens Endovascular Center as he describes the details of Dialysis Access Management:
- Why is it important for a patient to have a fistula or graft for dialysis access?
- What happens when your access becomes dysfunctional?
- Can angioplasty help with Dialysis Access Management?
- How should I care for my access?