You may have a fistula to help make dialysis effective and possible. This surgical connection between an artery and a vein sometimes gets blocked. We can detect a clot or narrowing of your fistula by taking X-ray images. We call this a fistulagram. During a fistulagram, we can fix any problems.
Learn what to expect during a fistulagram. This is an important part of your care for kidney failure.
Why Do I Need a Fistulagram?
You may be having symptoms that suggest a blockage of your fistula.
- A blockage in your fistula may cause high venous pressures during your dialysis.
- Your fistula may be completely blocked if you can't feel a thrill (motion of blood flowing through it.)
The blood vessels that are connected to the fistula get higher rates of blood flow and pressure. Often, this can make scar tissue form. Scar tissue narrows the fistula or blood vessels.
A fistulagram can find exactly:
- Where the artery or vein is blocked
- How severe the blockage is
- What's causing the blockage
Preparing for a Fistulagram
If you are already a patient in the hospital, your doctors and nurses will provide you with instructions. If this will be done on an outpatient basis, you should:
- Have no solid food within 6 hours of your scheduled appointment; you may drink clear liquids (such as apple, grape, cranberry juices, soda, water and tea) up to 2 hours before the procedure.
- Let us know right away if you take glucophage, insulin or a blood thinner so that we can adjust your dosage. Take your other medications as usual.
- Let us know if you have an allergy to X-ray (contrast) dye so that we can take the necessary precautions.
- Bring a list of all of your medications or your medication bottles with you on the day of the procedure.
- Get someone to drive you home.
What to Expect During a Fistulagram
We insert a needle into your fistula. You will feel warm in your hand, arm and chest. You may get a metallic taste in your mouth. These sensations only last 10-15 seconds. Several x-ray pictures are needed to complete the test.
If we find an area of narrowing or a clot present in the blood vessel, we may do a procedure to improve blood flow. We may do this with:
- Balloon angioplasty or stent
- Clot-dissolving medication
- Clot-breaking device
A fistulagram usually takes 2-3 hours to complete.
After the Fistulagram
Have Your Sutures Removed
Sometimes sutures are placed in the skin around the puncture sites because of the possibility of prolonged bleeding. These are visible blue or black threads overlying the puncture zones in your dialysis graft. These sutures only need to remain in place long enough for the puncture sites to heal.
At your next dialysis session, ask your dialysis nurse to remove these sutures. It is very important that you have these sutures removed in 2-3 days.
Monitor Your Fistula
Monitor your fistula frequently. A good thrill in your fistula indicates good blood flow through the vein. A good pulse in your fistula indicates good blood flow through the artery. You are the best person to judge how well your fistula is working. Also, have your dialysis nurse call us if they have difficulties using your fistula for dialysis.