Patient Name: ,
DOB: SEX:
Ordering Physician: ,
Procedure: upper extremity AV fistulogram
Indication: Decreased function dialysis.
Date:
Operators: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
Medications:
Fluoro time:
Contrast: cc s nonionic
Access site:
Complications: None immediate
The risks, benefits, and alternatives to the procedure and sedation were explained. The specific risk of fistula occlusion was detailed and accepted. Written informed consent was obtained.
The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure.
The _______AV fistula and overlying soft tissues were prepped and draped in sterile fashion. Ultrasonographic evaluation of the fistula and outflow was performed and an appropriate puncture site chosen. Images were transferred PACS. Under ultrasound guidance, the outflow vein was punctured antegrade with a 21 gauge needle. Needle entry was documented and an image stored. A 0.018″ wire was passed centrally and the needle exchanged for a F transitional dilator.
Diagnostic fistulography was performed from the access point to the right atrium using nonionic contrast.
Findings:
Impression:
Normal AV Fistulagram
Frequently Asked Questions
What is an AV fistulogram?
An AV fistulogram is a diagnostic imaging procedure used to evaluate the blood flow and function of an arteriovenous (AV) fistula, commonly used for dialysis. It involves injecting contrast dye into the fistula and taking X-ray images to ensure it's functioning properly. It's particularly useful for identifying any blockages or narrowing in the fistula.
During an AV fistulogram, a healthcare provider will access the fistula, usually in the arm, using a fine needle. A contrast dye is then injected to visualize blood flow. The procedure is monitored with real-time X-ray images, often using fluoroscopy, to assess any issues. The entire process is usually well-tolerated and takes about 30 minutes to an hour.
What are the risks associated with an AV fistulogram?
While an AV fistulogram is generally safe, there are some risks, such as infection, bleeding, or bruising at the access site. Rarely, the procedure can cause the fistula to occlude, or block, requiring further intervention. The use of contrast dye also carries a small risk of allergic reaction or kidney issues, particularly in patients with pre-existing kidney problems.
Why would a doctor order an AV fistulogram?
A doctor may order an AV fistulogram if there are signs of decreased function in a dialysis fistula. This might include issues like poor blood flow during dialysis sessions, swelling, or changes in the thrill or bruit of the fistula. The procedure helps determine whether there's a blockage or narrowing that could affect dialysis efficiency.
What should a patient expect during an AV fistulogram?
Patients can expect to be positioned comfortably and have their arm prepped in a sterile fashion. A local anesthetic may be used to minimize discomfort. Throughout the procedure, vital signs are monitored, and the patient is usually awake but may receive mild sedation. Afterward, patients can typically resume normal activities, barring any specific instructions from their healthcare provider.
What is the role of ultrasound in an AV fistulogram?
Ultrasound plays a crucial role in AV fistulograms by helping to identify the best puncture site and guiding the needle's insertion. It provides real-time images that ensure accuracy and safety during the procedure. Ultrasound is non-invasive and doesn't use radiation, making it an essential tool for vascular access.
What does a 'normal AV fistulogram' mean?
A 'normal AV fistulogram' indicates that the fistula is functioning as expected, with no blockages, narrowing, or other abnormalities detected. This means blood can flow smoothly through the fistula, which is crucial for effective dialysis treatment. A normal result reassures both patients and healthcare providers that the fistula is in good condition.