WHAT TO EXPECT DURING YOUR VISIT

• NEW ACCESS CONSULT

  • Will be seen at one of our 5 outpatient office/labs by one of our physicians.

  • When you are referred for a new access, we will evaluate your overall medical condition and anatomic suitability for a fistula (using your own veins) or a graft (using an artificial tube). We can also discuss the options of hemodialysis or peritoneal dialysis, although this is often decided before you see us with your nephrologist. We can almost always gather all information needed at a single visit.

  • We also check the blood pressure in your ankles if you are over 40 or have any symptoms of poor circulation (5 minute test).

  • We will discuss your situation, kidney failure in general, and go over options and recommendations.

  • Although at times it takes longer, the initial visit usually takes only 30 to 45 minutes.

  • We control our own operating rooms and can schedule you within 24 hours if desired. There is seldom an emergency, but especially if you have a catheter, the sooner the better in terms of your health.

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• ACESS CREATION

  • Whether hemodialysis fistula or graft or peritoneal dialysis catheter placement is chosen, this is done in our FLOW Vascular Institute CDAC Hospital in Pasadena (Vista Road near the beltway).

  • We typically try to admit patients the night before for medical evaluation and laboratory testing, and perform our elective operations in the morning. Patients typically will be home a few hours after operation.

  • We most often use a nerve block with sedation, administered by an anesthesiologist.

  • You will see your surgeon the morning of operation, although if things are routine postoperative communication is usually through our physician assistants. In most cases we call your dialysis center directly to go over plans with your providers there.

  • You will receive a “fistula map” showing exactly what we did and what the plan is – please remember to BRING THIS TO YOUR DIALYSIS CENTER after surgery!

  • We have a dialysis center in our hospital, and same day dialysis is frequently performed.

  • This can be a long day for you, but we can accomplish everything needed in ONE visit over 90% of the time.

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• WHEN IS YOUR ACCESS READY TO USE?

  • The simplest fistulas (radiocephalic, brachiocephalic, basilic transposition) need about 6 weeks to “mature.” This means that the vein walls get thicker, the vein itself gets larger, and the surrounding tissue heals up.

  • We often will do a brachiobasilic fistula in TWO STEPS – first is the connection itself, and after 6 weeks or so a second step is needed to bring this deep vein up to the surface and put it in a more comfortable place for use. It is generally ready about 2 weeks after this (8 weeks total).

  • An artificial graft is usually ready to use within a few days (immediately, if necessary).
     

• FOLLOW-UP PROCESS

  • We typically see our patients two weeks after surgery just to make sure no problems have occurred. If you have a graft which is being used, we’ll take out your cathter at this time.

  • If you have a simple fistula, we’ll see you 5 or 6 weeks out with an ultrasound to see if it is ready to use. If so, we’ll give you information to take to your center, and bring you back in 2 weeks for catheter removal.

  • If you have a two stage brachiobasilic fistula, we’ll schedule your second stage (“transposition”) about 6 weeks after the first step, with plans to clear this for use 2 weeks after that.

  • If your fistula is not ready to use by 8 weeks (or you have certain problems before) we will aggressively work to find and fix any problems, usually with a fistulagram (X-ray study of your fistula or graft). This can be done in one of our outpatient clinic/labs.

  • A peritoneal dialysis catheter is usually ready to use after about 2 weeks. We will communicate with your center regarding timing.
    
     

• ONGOING

  • Once your access is being used, we typically ask to see you every three months for the first year, and every 3 to 6 months after that. The purpose is three-fold – first, to check the fistula itself (usually with ultrasound), second, to check the health of your skin where you are being cannulated, and third, to make sure your hand is receiving adequate blood flow. We do not obtain a fistulagram unless your center requests it for a specific problem.

  • A fistulagram is performed if a specific problem is present, usually swelling or poor function. This is done at any of our locations, and consists of local anesthetic and placement of a small catheter (smaller than your dialysis needle). We then inject contrast dye to get a picture of the blood vessels. Problems can be treated with a balloon or a stent, if appropriate. If surgery is needed this will be done at a later date, after full discussion, at our Pasadena FLOW Hospital locaton.

• IF YOU HAVE POOR CIRCULATION

  • Let us know of any leg problems when we see each other.

  • If your ankle pressure is low, we will recommend a more sophisticated ultrasound. This can be done electively in one of our clinics, or at the FLOW Hospital if you are having an access placed. Depending on the findings, one of our Limb Salvage Center surgeons will sit down and go over results and recommendations.