Fistulagram Patient Education

Pre-Procedure Patient Information

What is a Fistulagram?

A fistulagram 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 fistulagram helps to detect these problems. It also lets your health care provider know of any additional treatment you may need.

Sometimes, is possible to open the narrowing or blockages during the fistulagram with angioplasty, by placing a stent or by using special medications during the procedure. Angioplasty is when a balloon is placed through the catheter to the narrowed area and inflated to open the vessel. The balloon is then removed. A stent could also be placed through the catheter to the narrowed area. A stent is a mesh tube that will stay in place to open the vessel and facilitate blood flow.

What conditions should I make sure my doctor is aware of?

Before your exam, you should notify the doctor or nurse of:

  • Any drug/food allergies
  • Allergies to IV contrast
  • Any blood thinning medications (anticoagulants) that you are taking
  • Any medical conditions you have
  • If you have an active infection
  • Whether you are pregnant or may be pregnant
  • Any problems you or your family members have had with anesthetic medications

What are the risks?

Generally, this is a safe procedure. However, as with any procedure, complications can occur. Possible complications include:

  • Bleeding
  • Infection
  • Allergic reaction to the dye or contrast used
  • A blood clot in the dialysis fistula
  • A blood clot that travels to your lungs

About the Procedure

Before the procedure:

  • Your health care provider may want you to have blood tests. These tests can help tell how well your kidneys and liver are working. They can also show how well your blood clots.
  • Do not eat or drink within eight hours of your appointment.
  • If you have diabetes and use insulin, you may need to adjust the dosage of insulin the day of the procedure. Your primary care doctor can help you with this adjustment.
  • If you are on blood thinning medications, you may need to stop them prior to the procedure. Check with your primary care doctor about when it is safe to stop blood-thinning medicine.
  • Do not discontinue any medication without first consulting with your primary care or referring physician.
  • Do not take new dietary supplements or medicines during the week before your procedure unless your health care provider approves them.
  • Plan to have someone take you home and stay with you for the first 24 hours after you leave the hospital. You should not drive or operate heavy machinery for at least 24 hours after the procedure. 

The day of the procedure:

  • Make sure you shower on the day of your procedure, washing the anticipated access site with soap and water.
  • If you are told to take a medication or to continue taking a medication on the day of the procedure, take the medication with a small sip of water.
  • Please arrive and register at admissions in the lobby of the hospital at your scheduled time.
  • You will be escorted to the prep area, where you will be connected to a blood pressure machine that will take your blood pressure and your heart rate. You will also have electrocardiogram (ECG) leads placed on your chest to allow us to monitor your heart during the procedure.
  • A nurse will insert an IV into your arm. During the procedure, this IV may be used to give you medications. These medications may include medicine to help you relax and reduce pain. The nurse will also review your medical history and medications, listen to your heart and lungs and make sure you have followed all your pre-procedure instructions.
  • Your physician will obtain your consent for the procedure. The physician will explain the procedure including possible complications and side effects. They will also answer any questions you may have.

During the procedure:

You will be awake during the procedure. You will be positioned on your back for the procedure. Let the staff know if the position is not comfortable. The access site for the catheter will be cleansed with a special antiseptic solution. Sterile drapes will be placed. The doctor will inject a small amount of local anesthetic through a very small needle in the skin where the catheter will be inserted. It feels like a pinch and then a slight burning as the local anesthetic starts numbing the skin.

A needle will be used to access the fistula. Imaging (US) can be used to guide the needle into the fistula. A small amount of dye may be injected through the needle. An X-ray can then be taken to make sure that the needle is in the correct place. Using a wire, the needle will be removed and a catheter, which is thin and flexible, will be placed.

The catheter is guided by using a type of X-ray (fluoroscopy) to the area being examined. Dye is then injected into the catheter and X-rays are taken. As the contrast material passes through your body, you may feel warm. The dye helps to show where any narrowing or blockages are located. A guide wire and balloon-tipped catheter may be advanced to the 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. A stent could also be placed through the catheter to the narrowed area. A stent is a mesh tube that will stay in place to open the vessel and facilitate blood flow. If your physician determines the clot will be best treated by a clot-dissolving medicine (thrombolysis), this medicine can be delivered through the catheter. A mechanical device at the end of the catheter can also be used to break up the clot (thrombectomy). The catheter will then be removed.

In some cases, the catheter site will be closed with a stitch or two. Hand pressure may be held on the access site for a period of time. A special device may be placed on your wrist to help prevent bleeding if your wrist was accessed. Your skin will be cleansed, and a bandage will be applied.

After the procedure:

  • You will stay in the recovery area for observation for 30 minutes-2 hours
  • The insertion site will be checked frequently
  • You will be asked about your pain
  • The nurses will review your discharge instructions with you
  • You will then be discharged home. Someone must drive you home and stay with you for 24 hours.

Can I resume normal activities?

  • Do not drive or operate heavy machinery for 24 hours after the procedure
  • Resume your normal diet
  • Drink plenty of fluids for the first several days after the fistulagram. This helps flush the contrast out of your body.
  • Return to your normal activities when your health care provider says that it is safe
  • Do not lift anything that is heavier than 5 lb on the day of your procedure
  • Do not do anything strenuous with your arm for the rest of the day. Avoid household activities, such as vacuuming.
  • Return to the vascular clinic for removal or your stitches as instructed

What do I do for follow up Visits?

Please make a follow up appointment with your ordering physician for follow up care.

Contact Information:

Contact your ordering physician for any questions or concerns to include:

  • Insertion site problems to include:
    • Redness, swelling or pain
    • Fluid or small amount of blood
    • Puss or a bad smell
  • You have a fever that does not get better with medicine.
  • You feel like you may vomit or you vomit.
  • Your skin becomes itchy or you develop a rash or hives.

Get help right away if:

  • You have very bad bleeding from the insertion site.
  • You can no longer feel a vibration or buzz when you put your fingers over your fistula.
  • The limb that was used for the procedure swells or becomes painful, cold, blue or pale white.
  • You have chest pain.
  • You are short of breath or have trouble breathing.
  • You feel dizzy or you faint.

These symptoms may be an emergency. Get help right away. Call 911.

  • Do not wait to see if the symptoms will go away.
  • Do not drive yourself to the hospital.