Introduction of Needle and/or Catheter, Arteriovenous Shunt Created for Dialysis (Graft/Fistula); Initial Access with Complete Radiological Evaluation of Dialysis Access

Name of the Procedure:

• Common Name: Dialysis Access Evaluation and Initial Access
• Medical Terms: Introduction of Needle and/or Catheter, Arteriovenous Shunt for Dialysis with Radiological Evaluation

Summary

This procedure involves inserting a needle or catheter into a surgically created arteriovenous shunt (either a graft or fistula) to provide access for dialysis treatment. It includes a thorough radiological evaluation using fluoroscopy (real-time X-ray imaging) to document and assess the condition of the dialysis access.

Purpose

• Medical Condition: Primarily performed for patients with chronic kidney disease who require dialysis.
• Goals: To establish a reliable access point for dialysis and to evaluate and document the functionality and condition of the arteriovenous shunt.

Indications

• Patients with end-stage renal disease (ESRD) requiring regular hemodialysis.
• Poor functioning or complications from an existing dialysis access point.
• Newly created arteriovenous graft or fistula that needs initial access and evaluation.

Preparation

• Pre-Procedure Instructions: May include fasting for a few hours prior. Patients should inform their doctor about all medications they are taking, as some medications might need to be adjusted.
• Diagnostics: Blood tests, ultrasound, or prior imaging studies may be required to evaluate the condition of the shunt.

Procedure Description

1. Preparation: Patient's arm is cleaned and prepped.
2. Anesthesia: Local anesthesia is usually administered to numb the area.
3. Access: A needle is inserted into the arteriovenous shunt, followed by a catheter if needed.
4. Fluoroscopy: Real-time imaging guides the placement of the needle/catheter and evaluates the shunt.
5. Image Documentation: Fluoroscopic images are taken and documented.
6. Injection: A contrast dye may be injected to highlight the vessels and ensure proper functioning.
7. Evaluation: Full assessment of the dialysis access is performed and documented in the report.

Duration

The procedure typically takes around 30 to 60 minutes.

Setting

Generally performed in a hospital’s radiology department or an outpatient surgical center equipped with fluoroscopy.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Radiology Technologist
• Nursing Staff

Risks and Complications

• Common Risks: Minor bleeding, bruising, pain at the access site.
• Rare Risks: Infection, damage to the shunt, thrombosis (clot formation), allergic reaction to contrast dye.
• Management: Most complications can be managed with medications or minor interventions.

Benefits

• Expected Benefits: Improved dialysis efficiency, early detection of any issues in the shunt, and prevention of major complications.
• Realization of Benefits: Benefits are usually noticed immediately with improved dialysis sessions.

Recovery

• Post-Procedure Care: Monitoring for signs of complications like infection or excessive bleeding. Instructions for care of the access site.
• Recovery Time: Generally, patients can resume normal activities within a few hours to a day. Restrictions might be placed on heavy lifting or vigorous activities for a day or two.
• Follow-Up: Regular check-ups and dialysis sessions will continue as prescribed.

Alternatives

• Other Options: Peritoneal dialysis, continued use of a central venous catheter (temporary), or the creation of a new arteriovenous shunt.
• Pros and Cons: Peritoneal dialysis is home-based but involves regular care and maintenance. Central venous catheter carries higher risk of infection.

Patient Experience

• During the Procedure: Patients might feel pressure or slight discomfort during needle or catheter insertion and minor pain from the local anesthesia injection.
• Post-Procedure: Generally, minimal pain or discomfort, managed with over-the-counter pain relief if necessary. The patient may feel some soreness at the access site.

By understanding the procedure, risks, and benefits, patients are better prepared for what to expect and the outcomes they should aim for, making the experience smoother and less daunting.