Dialysis Access/ESRD Services

From surgical creation of dialysis access to minimally invasive procedures to help maintain a healthy access, our expert staff aim to navigate you through your journey as we work closely with your nephrologists/dialysis centers.

Vein Mapping
Mapping of arm vessels before the surgical creation of dialysis access has been shown to help achieve higher arteriovenous fistula (AVF) rates as well as an improved fistula success rate.

This is performed in the office using ultrasound and is painless.  Our board-registered Vascular Technologist, with years of experience, will perform the examination.  The exam takes 45-60 minutes.

Tunneled Catheter (Perma-catheter) Placement, Exchange & Removal

A hemodialysis catheter is a hollow tube used for removal and replacing blood to and from your body. The catheter is tunneled from the internal jugular (IJ) with the tip entering the atrium of the heart. An exit site for the catheter is in the chest wall, under the collar bone. A small cuff on the catheter at the exit site sits under the skin. This cuff helps to keep the catheter in place, as well as, help prevent bacteria from entering the body.

The end of the catheter (outside of the exit site) known as a hub has 2 lumen. One lumen carries blood to the dialysis machine, while the other brings blood back into the body once it has been cleansed by the machine. Each lumen has a clip and an end cap that prevent air from getting into or blood from leaking out of the catheter. We can perform hemodialysis catheter placements, exchanges and removals in our office.

This is a minimally invasive procedure in which a small tube known as a sheath is inserted into the fistula. Through this sheath, we are able to administer sedative medication and perform diagnostic and therapeutic interventions. X-rays are taken to identify narrow areas (stenoses) within your fistula/graft. If stenoses are identified a balloon can be used to widen the narrowing (angioplasty) to restore improved flow in your fistula/graft.
If your fistula/graft clots, a procedure similar to a Fistulagram is performed to remove all the clot and restore the adequate flow in your fistula/graft.
There are times when angioplasty (ballooning) is ineffective and a stent may be placed. A stent is a spring metal mesh placed inside the vein or graft to keep the vein/graft open.
Fistula Maturation
Once a fistula is created (vein is connected to the side of an artery), it usually takes about 2 months before the fistula is mature and ready to start using for dialysis. If the fistula is slow to mature, a fistulagram is done to identify the cause. If there is a narrow area present limiting flow in the fistula, balloon angioplasty will be performed to promote maturation. Sometimes there are large branches present taking flow away from the fistula. If this is causing the fistula to be slow to mature, a coil can be placed into this branch to stop flow in the branch in order to have all the flow going into the fistula.


Warning Signs:

A Functioning Vascular Access is Vital for Dialysis. Warning Signs Your Access May Be Failing –


  • Prolonged Bleeding
  • Pain
  • Difficult Cannulation
  • Arm Swelling
  • Aneurysm Formation/Growth
  • High Venous Pressures
  • No Thrill/Change in Thrill
  • Infiltration
  • Non-maturing Fistula
  • Redness/Drainage
  • Poor Clearance
  • Clotting of Needles or Lines
  • Abnormal Arterial Pressures
  • Recirculation
  • Poor Flow


  • Pain
  • Poor Catheter Flow (less than 300ml/min)
  • Redness/Drainage
  • Poor Clearance
  • Clotting of Lines
  • Recirculation
  • Unable to Aspirate

If you notice ANY of these symptoms, please inform your doctor or nurse immediately.

What can I do to keep my dialysis access healthy?

  • Examine your access daily to ensure there is a thrill
  • Keep site clean
  • Wash skin daily with soap and water
  • Avoid sleeping on your access arm
  • Avoid carrying heavy objects with your access arm
  • Avoid checking blood pressure on your access arm

I have a catheter:

  • Keep site clean and dry
  • Dressing changes will be done at dialysis center
  • Transition to a fistula or a graft as soon as possible

For more information please visit http://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/home/ovc-20211679