Services We Provide
Vein Mapping
This procedure involves taking measurements of arteries and veins in your arms using ultrasound technology to help assist the surgeons in evaluating the best vessels to use for creation of an AV fistula or graft before surgery. Sometimes, a venogram is performed in which contrast dye is injected through an IV into a vein to visualize the larger central veins in the chest using X-ray technology.
Peritoneal Dialysis (PD) Catheter Procedures
Percutaneous PD Catheter Placement
Using ultrasound and X-ray technology, a catheter is placed through a small incision (approximately 3-5 centimeters) to the side of the belly button and tunneled under the skin and through the abdominal muscle, into the peritoneal cavity, where the tip is positioned near the pelvis. One cuff is buried and sutured into the abdominal muscle and the other one is in the tunnel under the skin, both to reduce risk of leaks and infection. Local anesthesia and conscious sedation is used to perform this procedure. The doctor’s will review whether all criteria are met to complete this procedure any preparations needed prior to this procedure.
PD Catheter Exchange
If a catheter stops working or needs repositioned, a new catheter can be exchanged over wire usually through the same incision and tract, using X-ray technology. Usually a new tunnel under the skin will be created to reduce infection risk. Local anesthesia and conscious sedation will be used to perform this procedure.
PD Catheter Removal
If a peritoneal catheter is no longer needed, the catheter can be removed through the same incision made at time of insertion. Local anesthesia and conscious sedation will be used to perform this procedure.
Hemodialysis Vascular Access Repair and Maintenance
Angiogram
An angiogram using IV contrast dye and X-ray technology to visualize the tract of the AV fistula or graft. A local anesthetic is used in the skin over the AV access to insert an IV. Areas of stenosis or narrowing can be identified to determine whether further procedures are needed.
Angioplasty
If the angiogram shows an area of narrowing, a balloon can be positioned in this area of the vessel and inflated while using X-ray technology to ensure complete expansion or stretching to its original or expected size. The balloon is removed at the end of the procedure. Sometimes a stent (a metal scaffolding) is needed to keep the vessel open to its full capacity for better patency. The stent is expanded and remains adhered to the wall of the specific vessel and remains there at the end of the procedure.
Thrombectomy
If the AV fistula or graft has become obstructed by clot, reducing or eliminating flow through the access, this procedure utilizes balloons to suction/remove and break up the clot to restore blood flow through the access. Blood thinners such as heparin are also used in this procedure to assist with reducing clot burden. Once flow is restored, the access is evaluated with angiography to identify any narrowing that may have contributed to the access clotting, and treated accordingly.
Coil Embolization
If there are small side branches in the AV fistula that may be inhibiting the fistula’s ability to mature or reducing flow through the main outflow vein, these small branches can be clotted off by inserting a metal coil into those branches with precision using contrast dye and X-ray visualization in order to maximize flow through a single outflow vein.
Hemodialysis (HD) Catheter Procedures
HD Catheter Placement
A tunneled catheter is placed in the vein of the neck (or sometimes the groin) to obtain access to the blood vessel. The tunnel is created just under the skin in which area a cuff or ring anchors the catheter to the skin. This procedure is done with precision utilizing X-ray and ultrasound technology, under local anesthesia and conscious sedation.
HD Catheter Exchange
When a catheter stops working, it can be exchanged over guide wire through the same tunnel. This procedure generally does not require sedation, but only local anesthesia by numbing the exit site. Sometimes there is scar tissue surrounding the catheter in the vessel, known as a fibrin sheath, which requires disruption using a balloon before replacing the catheter in order to ensure good function of the newly replaced catheter.
HD Catheter Repair
When a clamp breaks, the tunneled catheter can usually be repaired simply by replacing the clamp. The entire catheter is only rarely exchanged if there is more extensive damage to the catheter ports.
HD Catheter Removal
A tunneled catheter is removed when it is no longer needed, either due to an alternative access or if dialysis is no longer needed. To remove the catheter, the exit site is numbed by local anesthesia. Once the cuff is freed from the skin, the catheter slides out and the exit site is covered with topical antibiotic and a dressing.