Fistulogram

What is Fistulogram

Fistulogram is an X-ray test to look inside the site where your blood is removed and returned to your body during dialysis (dialysis fistula). Your fistula allows easy and effective access, but sometimes problems can occur, such as narrowing or blockages.

A narrowing or blockage can reduce the effectiveness of dialysis. A fistulogram helps to detect these problems. It also lets your health care provider know of any additional treatment you may need.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any reactions you have had to contrast dye.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Pain, redness, or swelling in your limb with the dialysis fistula.
• Any bleeding from your dialysis fistula.
• Any of the following in the part of your body where the dialysis fistula leads:
  • Numbness.
  • Tingling.
  • Cold feeling.
  • Bluish or pale white in color.

What are the risks?

Generally, a fistulogram is a safe procedure. However, problems can occur and include:

• Bleeding.
• Infection.
• A blood clot in the dialysis fistula.
• A blood clot that travels to your lungs (pulmonary embolism).

What happens before the procedure?

• Your health care provider may do some blood or urine tests or both. These will help your health care provider learn how well your kidneys and liver are working and how well your blood clots.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do nottake these medicines before your procedure if your health care provider asks you not to.
• Do noteat or drink anything after midnight on the night before the procedure or as directed by your health care provider.
• Ask your health care provider if you will be able to go home after the procedure. Some people stay overnight in the hospital.
• Plan to have someone take you home after the procedure.

What happens during the procedure?

• A needle will be inserted into your arm. It will be used to give you medicine. Medicines given may include:
  • Numbing medicine (local anesthetic) to numb an area on the limb with your fistula.
  • A medicine to help you relax (sedative).
  • A medicine that makes you fall asleep (general anesthetic).
• When your skin is numb, a needle will be inserted into your vein.
• A thin, flexible tube (catheter) will be inserted into the needle and guided to the narrowed area.
• Dye (contrast material) will be injected into the catheter. As the contrast material passes through your body, you may feel warm.
• X-rays will be taken. The contrast material will show where any narrowing or blockages are.
• A guide wire and balloon-tipped catheter will be advanced to the blockage site.
• The balloon will be inflated for a short period of time. The balloon may be inflated several times at this site, or the balloon may be moved to other sites.
• If your health care provider determines the clot will be best treated by a clot-dissolving medicine (thrombolysis), this medicine can be delivered through the catheter instead of using the balloon.
• A mechanical device at the end of the catheter can also be used to break up the clot (thrombectomy).
• At the end of the procedure, the catheter will be removed.
• In some cases, the catheter site will be closed with a stitch or two.
• Pressure will be applied to stop any bleeding, and your skin will be covered with a bandage (dressing).

What happens after the procedure?

• You will stay in a recovery area until the medicines have worn off.
• You will stay in bed for several hours.
• As you begin to feel better, you will be offered ice and beverages. You may be given food.
• Your health care provider will check your blood pressure and pulse and watch your access site.
• When you can walk, drink, eat, and use the bathroom, you may be discharged.

Fistulogram, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information on caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After your procedure, it is typical to have the following:

• A small amount of discomfort in the area where the catheters were placed.
• A small amount of bruising around the fistula.
• Sleepiness and fatigue.

Follow these instructions at home:

• Rest at home for the day following your procedure.
• Do notdrive or operate heavy machinery while taking pain medicine.
• Take medicines only as directed by your health care provider.
• Do nottake baths, swim, or use a hot tub until your health care provider approves. You may shower 24 hours after the procedure or as directed by your health care provider.
• There are many different ways to close and cover an incision, including stitches, skin glue, and adhesive strips. Follow your health care provider’s instructions on:
  • Incision care.
  • Bandage (dressing) changes and removal.
  • Incision closure removal.
• Monitor your dialysis fistula carefully.

Contact a health care provider if:

• You have drainage, redness, swelling, or pain at your catheter site.
• You have a fever.
• You have chills.

Get help right away if:

• You feel weak.
• You have trouble balancing.
• You have trouble moving your arms or legs.
• You have problems with your speech or vision.
• You can no longer feel a vibration or buzz when you put your fingers over your dialysis fistula.
• The limb that was used for the procedure:
  • Swells.
  • Is painful.
  • Is cold.
  • Is discolored, such as blue or pale white.