Dialysis Access Management

Our team offers various services that ensure the best dialysis access treatments possible.

After a patient has a hemodialysis fistula or graft created, the access site usually requires maintenance to function optimally. Our team communicates with the dialysis centers to ensure the proper functionality of the access site and perform procedures to keep the access working as long as possible. If a patient requires more extensive treatment, regular access to their veins may become necessary, in which case our team will put them on a schedule to diagnose, monitor, and access the afflicted veins as needed.

Vessel Mapping

In order to best determine the best location for a fistula or graft placement, a physician may first use vessel mapping. This process involves using ultrasound guidance to locate and measure the upper extremity arm veins and evaluate the arterial inflow.

Complete Tunneled Catheter Placement Services For Hemodialysis

In some cases, a patient may need to be dialyzed until their fistula or graft is matured/ready for use. Thus, our team will provide the patient with complete catheter services.

Tunneled catheters require a set of two different dialysis channels: the first removes the patient’s blood to run it through the dialysis machine, whereas the second reintegrates the purified blood. In most cases, tunneled dialysis catheters are inserted through the neck (via the jugular vein) or just below the collar bone.

Our team will use ultrasound technology in order to efficiently and expediently place the catheter properly.


When a physician suspects a patient may need their access evaluated, they will request a fistulogram. A fistulogram will look to see where the issue is that is causing suboptimal dialysis. Common dialysis problems include:
● High venous pressures
● Low blood flow rates
● Prolonged bleeding
● Weak thrill or bruit
● Difficulty with cannulation
● And more

Fistula Maturation Procedures

After placement of a surgical or endovenous dialysis fistula, the draining vein must have time to mature/enlarge for optimal use. This process usually takes 4-8 weeks to develop.

Should the fistula maturation process not progress as expected, a fistulogram may be necessary to evaluate the access site. Interventions include dilating areas that are narrowed or plugging small adjacent veins to promote blood flow into the main draining vein. These treatments will effectively reroute the blood flow to give the fistula a chance to mature.

Thrombolysis/ Thrombectomy

Should your dialysis access be blocked as a result of a blood clot or fibrin sheath, a procedure will be necessary to restore blood flow for dialysis. Percutaneous Thrombolysis/ Thrombectomy or catheter replacement may be necessary.

No matter the condition, we can provide the necessary care to return each patient for successful hemodialysis. This treatment may involve…
● The use of a catheter to mechanically break up the blood clot
● Changing out the catheter over a wire
● Or using medication to dissolve the blood clot in question