Patient education: Fistulogram of hemodialysis access (The Basics)

What is a fistulogram? — 

This is a type of imaging test. It is used to look at the arteriovenous, or "AV," access used for hemodialysis.

An AV access connects an artery and a vein. It is a way for blood to leave and return to the body during hemodialysis. There are different types of AV access, including an AV fistula (figure 1) and an AV graft (figure 2).

If your AV access is not working well, it might be blocked or narrowed. The doctor might order a fistulogram to learn more about your AV access. They will inject a dye into your access. The dye shows up on X-ray and shows how blood moves through your body.

How do I prepare for a fistulogram? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all your medicines with you.

●Any allergies you have, including allergies to contrast dye

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – You might need to "fast" before your procedure. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during a fistulogram?

●You will get an "IV," which is a thin tube that goes into your access. This can be used to give you fluids and medicines.

●You might get medicines to make you relax and feel sleepy, called "sedatives."

●The staff will give you a dye called "contrast" through the IV. You might get a warm feeling when the dye is given. You might also have a metallic taste in your mouth. This is normal and will go away in a few minutes.

●As the dye is given, the doctor will use fluoroscopy (a moving X-ray) to see the blood flow through your AV access.

●If there is a blockage, the doctor might try to open it up with medicines, or with a thin wire and a balloon. They might need to place a "stent" (a small tube) in your AV access to help keep it open.

●The doctor will remove the IV. They might need to use stitches to stop any bleeding.

●A fistulogram usually takes about 30 minutes. But it can take an hour or longer.

What happens after a fistulogram? — 

The staff will make sure you are not bleeding from your AV access. Then, you can probably go home.

●If you got medicines to help you relax, you will need someone to bring you home.

●You can go back to your normal activities and normal diet when you go home.

●You might need to limit lifting with your arm for about 1 day.

●If you have stitches, you will need to have them taken out. Your doctor or dialysis nurse will usually want to do this in 1 to 2 weeks.

What are the risks of a fistulogram? — 

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding

●Damage to the AV access

●Allergic reaction to the contrast dye

What else should I know? — 

Before you go home, make sure you know what problems to look out for and when you should call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Arteriovenous vascular access for hemodialysis (The Basics)
Patient education: Hemodialysis (The Basics)
Patient education: Chronic kidney disease (The Basics)

Patient education: Hemodialysis (Beyond the Basics)
Patient education: Chronic kidney disease (Beyond the Basics)