Hemodialysis Management

Hemodialysis management provides kidney replacement therapy to patients with kidney failure either as a regular maintenance or on an emergency basis.


Fistulagram

A fistulagram is also called an artificial graft. The purpose of a fistulagram is to evaluate renal access to a surgical fistula/graft (synthetic connection of an artery and a vein) that is not functioning properly. A fistulagram may show that the blood flow is not high enough, pressures in the vein are too high or the graft is clotting frequently.

The procedure involves placement of a tiny needle (smaller than a dialysis needle) into the fistula/graft and injection of contrast dye, which enables visualization within the fistula/graft. Treatments such as venous angioplasty/stent (renal dialysis access) may be performed to treat blockages that are detected.

««return to top


Fistulagram Declotting, Angioplasty and Stenting

Venous angioplasty is a non-surgical procedure that can be performed during a venogram to open or bypass narrowed veins and prevent clotting. Venous angioplasty can also allow for placement of a small device called a stent, which supports a vessel or tissue in an open or expanded position to allow bypass of scarred tissue and improve blood flow.

For a venous angioplasty procedure, an X-ray of the veins is performed. Once blocked or narrowed vessel(s) are identified on the venogram, a balloon-tipped catheter is inserted into the blocked vein and guided under fluoroscopic X-ray to the area of concern. The balloon is inflated to correct the blockage and enable blood flow. In some circumstances, a stent is mounted on the balloon-tipped catheter. When the balloon is inflated, the stent is expanded and adheres (permanently) to the walls of the vessel to keep it open.

««return to top


Advanced Hemodialysis Vascular Access, Including Recanalization of Blocked Vessels

Patients with advanced kidney failure usually require dialysis. Hemodialysis is one form of dialysis in which blood is circulated through a special cleansing machine and returned to the body.

Patients in need of hemodialysis access may be sent by their kidney doctor to the Interventional Radiology Division for placement of a plastic tube, or hemodialysis catheter, into a large vein at the base of the neck, which is connected to a hemodialysis machine. A specialty-trained interventional radiologist will use advanced equipment to place the catheter. Once in place, this catheter is securely fixed to the skin and can remain in place for weeks to months. This catheter will need special care, which is explained to the patient at the time of catheter placement.

««return to top


Lifeport Hemodialysis Ports

Hemodialysis works by circulating the blood through special filters. Before hemodialysis can be performed, there needs to be adequate access to the circulatory system. However, a normal IV will not support the volume required for hemodialysis. For this reason, a special type of arterial and venous access is established.

The access can be either external or internal. External access involves two catheters — one that is placed in an artery and one in a nearby vein, or two catheters positioned within different parts of a large vein. External access is typically only used in emergency situations.

Internal access can be either an arteriovenous (AV) fistula or graft. A fistula involves the surgical joining of an artery and vein under the skin. The increased blood volume stretches the elastic vein to allow a larger volume of blood flow. After the four to six weeks the fistula needs to heal, needles can be placed so that arterial blood can be pulled off for dialysis and the cleansed blood returned through the dilated vein.

A graft may be used for people whose veins are not suitable for a fistula. This procedure involves surgically grafting a donor vein from the patient's own saphenous vein (in the leg), a carotid artery from a cow or a synthetic graft from an artery to a vein. After there is adequate access with two ports, a hemodialysis machine is connected to cleanse the blood.

««return to top


Translumbar and Transhepatic Hemodialysis Catheter Placement

Use of the right internal jugular vein (IJV) to insert a catheter for hemodialysis avoids many of the risks associated with subclavian vein access. However, when IJV access is no longer feasible, catheters at other locations provide viable alternative routes.

««return to top


Peritoneal Dialysis Catheter Placement

When kidneys fail, waste products such as urea and creatinine build up in the blood. One way to remove these substances is a process called peritoneal dialysis (PD). The walls of the abdominal cavity are lined with a membrane called the peritoneum. During PD, a mixture of dextrose (sugar), salt and other minerals dissolved in water, called dialysis solution, is placed in a person's abdominal cavity through a catheter. The body's peritoneal membrane allows waste products and extra body fluid to pass from the blood into the dialysis solution. These waste products then leave the body when the solution is drained from the abdomen. In some people, the peritoneum does not allow waste to enter the dialysis solution efficiently enough to make PD feasible.