Vascular Access Declotting

Questions and Answers about Declot of Hemodialysis Access
Today you had a procedure that declotted your fistula or graft. Someone will need to stay with you for the rest of the day to watch you and help you with your daily activities. This brochure will answer some of the more common questions regarding the declot procedure.

Q: Why did my access clot in the first place?
A: There are many reasons why accesses clot. Some of the more common causes are:

• Low blood pressure for extended periods of time.
• Sleeping on your arm or keeping your arm bent for long periods of time.
• Wearing tight or restrictive clothing, especially at the wrist or elbow.
• Functional problem with the anatomy of your blood vessels.

Q: Is this declot procedure painful?
A: The doctor will use a numbing medicine that has a tendency to sting when it is first injected. Once the numbing medicine is active, you should not feel any pain. You will also receive medication to make you feel sleepy and to help with pain.

Q: What happens during a declot?
A: The interventional radiologist will inject medication into the fistula or graft to loosen the clot and then remove the clot with a temporary balloon. The goal is to re-establish flow to the fistula or graft. Occasionally, further procedures will need to be performed to improve the flow through the fistula or graft. This will be decided at the time of the declot.

Q: What should I look for after my declot?
A: You should develop the habit of checking your access several times per day, by:

• Listening for the “bruit” (brew-ee) – A bruit is the whooshing sound that you can hear by placing your ear up to the access.
• Feeling the “thrill” – The thrill is the powerful pulse that you feel by gently placing your fingers over the fistula or graft.
• If you do not hear the bruit or feel the thrill, you should contact someone immediately. Do not wait until dialysis day – you can contact your hospital emergency department, dialysis unit, primary doctor's office, kidney doctor's office, or surgeon's office. The key is to call someone immediately.

Q: What other signs should I be looking for after the declot?
A: You should call your doctor if you:

• Develop a fever.
• Notice that there is pain, redness, swelling, bleeding or drainage coming from the treatment site.

Q: How should I take care of myself at home after the declot?
A: You will feel sleepy for the rest of the day because of medicines given to you during the procedure. It is a necessary to have someone stay with you for the rest of the day. Having someone to watch you and to assist you with your daily activities is a good idea.

Q: Can I drive after this procedure?
A: No, you must have someone drive you home or back to the dialysis unit. You should not drive, operate heavy machinery, or make important decisions for the day.

To care for you AV fistula or graft, follow these instructions:

DO:

• DO examine your fistula or graft every day by:
  • Listening for “rushing sound”, called a bruit {brew-ee}
  • Feeling for a powerful pulse, called a “thrill”.
• DO call your doctor immediately if:
  • You cannot hear the bruit or feel the thrill, as this could be a sign that the fistula has clotted.
  • You notice redness, swelling or drainage from your fistula.
  • You develop a fever or feel very ill.
• DO keep your fistula clean and dry.
• DO hold light pressure to your needle “sites” after dialysis.

DO NOT:

• DO NOT allow anyone to take blood pressures on your fistula arm.
• DO NOT allow anyone other than dialysis or emergency staff to take blood samples directly from your fistula.
• DO NOT allow blood samples to be drawn anywhere from your fistula arm.
• DO NOT wear tight or restrictive clothing on your fistula arm.
• DO NOT sleep on your fistula arm.
• DO NOT bend your fistula arm for long periods of time.
• DO NOT allow clamps to be placed on your needle “sites” after dialysis if possible.