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Your Care at the Center
What kinds of physicians provide care at the Center?
Our physicians are either board-certified surgeons or interventional radiologists trained in performing vascular access procedures using minimally invasive techniques.
What facilities are at the Center?
The Center consists of procedure rooms, a recovery area, examination rooms, a waiting room, a conference room, and ancillary spaces such as offices and storage areas. The Center is equipped with up-to-date diagnostic technologies such as ultrasound and X-ray.
How is the Center staffed?
The Center is staffed by experienced Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and nurses trained in conscious sedation and dialysis.
What kind of emergency back-up is there if something goes wrong?
Emergency back-up, if needed, is provided by Beth Israel Deaconess Medical Center.
What are minimally invasive or subcutaneous techniques?
The Center uses these techniques whenever possible. The physician inserts tiny instruments through small incisions and performs the procedure under the skin (subcutaneously). Visibility is provided by imaging technology such as X-ray or a tiny television camera that projects images on a screen. Minimally invasive procedures, an alternative to open surgery, benefit the patient by reducing infections, minimizing pain and speeding recovery. A benefit for kidney failure patients is that the vascular access can typically be used right away.
What should I expect if I am referred to the Center for evaluation of an existing vascular access or pre-operative mapping of my arm veins before access placement?
In this procedure, our physicians use ultrasound to identify the veins and arteries that are most likely to produce successful vascular accesses. Ultrasound is a diagnostic tool that uses high-frequency sound waves to produce digital images. The procedure is painless and does not require sedation. It is typically completed in 15-20 minutes. The doctor places ultrasound gel on the patient’s arm and then applies a probe to create a digital image of the veins and arteries.
What should I expect if I am referred to the Center for a diagnostic X-ray (AV fistulogram)?
Our physicians take diagnostic X-rays, or fistulograms, to determine exactly how well your vascular access is working and to determine whether intervention is needed. The 15-20 minute procedure does not require sedation. The patient’s arm is placed on an arm board to hold it firm while the X-ray is taken. The arm is prepared with an antiseptic to create a sterile environment. The physician places a small needle into the access, then replaces it with a plastic sheath through which he injects contrast dye into the access. The physician operates the X-ray machine by pressing a foot pedal.
What should I expect if I am having a balloon angioplasty?
Balloon angioplasty is used to treat narrowing (stenosis) of veins and arteries that may block blood flow and reduce the effectiveness of dialysis. The entire procedure, including recovery time, is usually completed in 1 1/2-2 hours.
The patient is given conscious sedation, which means he or she is awake but given a relaxant and a pain reliever to reduce discomfort. In addition, the incision site is numbed with a local pain killer. The patient may feel pressure during the procedure, but does not usually experience pain.
The physician places a small needle into the access and inserts a wire through the needle. He or she then removes the needle, replaces it with a plastic sheath, and injects dye through the sheath to provide contrast for the X-ray machine. If the X-ray shows that the blood vessel has narrowed, the physician may decide to perform an angioplasty. The physician then inserts a larger sheath through which a collapsed balloon is inserted in the vessel. An inflator enlarges the balloon. The physician adds more contrast dye to show that he or she has widened the narrowed vessel so that blood can flow more freely.
After the procedure, the patient spends about 30 minutes in the recovery area.
What should I expect if I am having a percutaneous thrombectomy?
Percutaneous thrombectomy is minimally invasive removal of a blood clot, usually with suction. The entire procedure, including recovery time, is usually 1-3 hours.
The patient receives conscious sedation (see balloon angioplasty, above). After inserting a needle and a sheath, the physician removes the clot through a tube attached to a suction pump. Sometimes blood thinners are administered to prevent recurrence of clotting during the procedure. Thrombectomy is often followed by an angioplasty. After the procedure the patient usually spends 30-60 minutes in the recovery area.
What should I expect if I have been referred to the Center for catheter insertion, exchange or removal?
It is critically important to keep your catheter and port free from infections and blood clots. When these complications occur, our physician will remove your catheter, correct the problems and return a new catheter to the vein. The procedure requires conscious sedation and a local painkiller, and is usually completed in about an hour including recovery time. After inserting a needle and a sheath, the physician searches for a strong vein in which to place the catheter. He or she may also remove a poorly functioning catheter and replace it with another one that is inserted over a wire in the existing tunnel. Recovery time is usually 30 minutes.
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