Fistulagraphy

Questions and Answers about Fistulagraphy
You have had an AV (arteriovenous) fistula or graft created to treat your renal failure. Your doctor has asked us to perform a fistulagram to evaluate your fistula or graft. Here are the answers to some commonly asked questions about fistulagraphy.

Q: What is an AV fistula or graft?
A: An AV fistula is a dialysis access that is created by connecting an artery to a vein, sometimes with graft material, during a short surgery. AV fistulas can be created anywhere from the wrist through the upper arm.

Q: Why is an AV fistula or graft necessary?
A: The process of hemodialysis requires that blood pass through an artificial kidney. With a fistula or graft, blood from the arterial side of the fistula or graft passes through a needle into the artificial kidney, is cleaned, and returns to the body through a needle in the venous side. A fistula or graft is useful because arteries are deep in your body and would be difficult to get an access needle into. Veins are closer to the surface of your skin, are easier to see, and are easier to get needles into for hemodialysis.

Q: What happens when an artery is connected to a vein?
A: Arteries have very high blood flow through them. Veins have lower blood flow through them. When an artery is connected to a vein, the vein will “mature”. It will grow in size and expand in order to accept the higher blood flow.

Q: Why is high blood flow through a fistula necessary?
A: The higher the blood flow from your access, the more times your blood will go through the artificial kidney. This will create a more efficient dialysis.

Q: Why do I need to have my fistula or graft evaluated?
A: Your kidney doctor or dialysis center has noticed that your fistula or graft is not working as well as it should. This may mean that you are having low flows through the fistula or graft, increased pressures, or increased bleeding.

Q: What is a fistulagram?
A: A fistulagram is an exam where contrast dye is injected into the fistula or graft with a small catheter placed into the fistula or graft. The arterial inflow and venous outflow of the fistula or graft is evaluated.

Q: What can be done to improve my fistula?
A: When arteries and veins are connected for hemodialysis, the veins will sometimes become narrowed due to the increased pressure of the arterial blood entering the fistula or graft. When this happens, an interventional radiologist or surgeon may perform a procedure called angioplasty, in which a temporary balloon is inflated in the fistula or graft or in the outflow veins to re-expand the walls. Occasionally an internal stent may also be needed to keep the vein open. These are procedures that can be done in the clinic during the fistulagram.

To care for your AC 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.