Dialysis Access Management

Dialysis access is a vital lifeline for patients with kidney failure. Our team monitors, repairs, and maintains access to keep dialysis running smoothly.

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Dialysis Access Management encompasses minimally invasive procedures to create, maintain, and restore function to arteriovenous fistulas (AVF) and grafts used for hemodialysis.

What is Dialysis Access Management?

Why is the Procedure Performed?

A functioning access site is essential for patients with end-stage renal disease (ESRD) receiving hemodialysis. Interventions may be needed for issues such as stenosis reducing blood flow, acute clots causing access failure, prolonged bleeding, aneurysms, high venous pressures, malfunctioning or new catheters, and assisting maturation of new fistulas. Prompt treatment helps restore access, prevent catheter dependence, and reduce the risk of infection.

How is the Procedure Performed?

Procedures are performed in an outpatient vascular suite under ultrasound and fluoroscopic guidance:

  • Assessment: Fistulogram or angiogram maps the access and identifies problems.

  • Angioplasty: A balloon catheter is inflated at stenotic segments to widen the vessel.

  • Stent Placement: If recoil or elastic narrowing persists, a stent is deployed.

  • Thrombectomy/Thrombolysis: Mechanical devices and/or clot-dissolving medications clear blockages, restoring flow.

  • Catheter Work: Exchange, reposition, or removal of tunneled dialysis catheters when indicated.

  • Hemostasis: Access sites are closed with manual pressure or a closure device.

Most procedures last 30–60 minutes. Patients are observed for 1–2 hours before discharge.

What are the Risks and Benefits?

Benefits

  • Restores or maintains adequate blood flow, ensuring effective dialysis.

  • Minimally invasive with rapid recovery.

  • Reduces need for surgical revision and central catheter placement.

  • Improves quality of life by minimizing missed dialysis sessions.

Risks

As with any medical procedure, a Peripheral Artery & Vein Intervention does involve potential risks. These may include:

  • Bleeding or hematoma at the puncture site.

  • Vessel perforation or dissection (rare, usually treated immediately).

  • Infection or allergic reaction to contrast dye.

  • Restenosis or re-thrombosis requiring repeat intervention.

Preparing for Your Dialysis Access Management Procedure

What to Expect

You will lie on an X-ray table. The access arm or catheter site is cleaned and numbed. Mild IV sedation keeps you relaxed. You may feel pressure but should not experience significant pain.

How to Prepare for Your Procedure

  • Fasting: Do not eat solid food for 4–6 hours prior; clear liquids are usually allowed.

  • Medication Review: Continue most medications; blood thinners may be adjusted per physician advice.

  • Dialysis Schedule: Coordinate timing so the intervention occurs shortly after a dialysis session when possible.

  • Transportation: Arrange a ride home; driving is not recommended post-sedation.

Medications to Discuss Before the Procedure

  • Anticoagulants/Antiplatelets: Warfarin, apixaban, clopidogrel, or aspirin doses may be modified—follow instructions.

  • NSAIDs: May be limited to reduce bleeding risk.

  • Herbal Supplements: Stop ginkgo, garlic, or ginseng 5–7 days prior.

What to Bring with You

  • Wear loose clothing allowing easy access to fistula/graft.

  • A complete list of all your medications, including supplements and over-the-counter items, and dialysis schedule.

  • Identification and insurance cards.

After the Procedure

  • Recovery: Staff monitor your vitals and access site; you can eat and drink when fully awake. Your nurse will confirm the vibration (thrill) over the fistula has returned.

  • Activity: Avoid heavy lifting or strenuous activity until cleared by your care team.

  • Site Care: Follow instructions carefully to Keep bandage dry for 12–24 hours; monitor for bleeding or swelling.

  • Dialysis: Resume as scheduled unless told otherwise.

Tips for a Healthy Recovery

  • Drink plenty of fluids unless otherwise directed by your physician.

  • Check thrill daily and report changes.

  • Avoid tight clothing, blood pressure cuffs, or venipuncture on the access arm.

  • Diet and fluid management per renal team guidance.

When to Call Your Doctor

  • Sudden loss of thrill, swelling, prolonged bleeding (>20 minutes), fever, or severe arm pain.

  • Contact your physician if redness, drainage, or access dysfunction recurs.

Have a Question? Check Here!

  • Dialysis Access Management refers to a range of procedures—such as angioplasty, thrombectomy, and stent placement—performed to create or maintain a functioning vascular access (fistula or graft) for hemodialysis.

  • A healthy access site ensures efficient dialysis, prevents interruptions in treatment, and reduces complications like clotting or infection.

  • Narrowing (stenosis), clot formation (thrombosis), aneurysms, high-pressure issues, and dysfunctional catheters can all be managed.

  • Regular monitoring is recommended every 1–3 months or sooner if you notice changes in thrill, prolonged bleeding, or swelling.

  • Most interventions are done under local anesthesia with mild sedation; you may feel pressure but minimal pain.

  • Most angioplasty or thrombectomy treatments take 30–60 minutes with a few hours of recovery.

  • Technical success exceeds 90% for angioplasty and 80–90% for thrombectomy, restoring adequate blood flow for dialysis.

  • Bleeding, infection, vessel injury, or recurrence of stenosis/clot are possible but serious complications are uncommon.

  • Some patients notice improvements in symptoms such as leg pain or swelling shortly after the procedure, but it can vary. The full benefits of the intervention may take several weeks to become evident as blood flow improves and your body heals.

  • In most cases, dialysis can be performed the same day or next session; your care team will advise.

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