Vascular Access Center
Nephrology Associates Vascular Access Center
Hemodialysis and Vascular Access
Procedures Performed to Maintain Vascular Access
What to Expect From Your Procedure
Address and Directions
Nephrology Associates Vascular Access Center
Nephrology Associates, P.A. is committed to providing the highest level of dialysis care to our patients. A healthy vascular access is a vital part of good quality hemodialysis. We have a group of interventional nephrologists dedicated to maintaining high quality hemodialysis access in our patients. An interventional nephrologist is a board certified nephrologist with additional training in the vascular access procedures described below. The physicians in our group with this specific training include Dr. Theodore Saad, Dr. Jeffrey Cicone, and Dr. Gertrude Findley-Christian. Karen Radcliff, R.N. is the vascular access program coordinator. She often performs initial patient evaluations, and also helps prioritize patients based on the level of urgency.
Our vascular access procedures are performed in multiple locations. The majority of procedures are scheduled in our Vascular Access Center in Newark, Delaware. We currently also perform selected procedures at St. Francis Hospital in Wilmington, Christiana Care Heath Services in Newark, Delaware and Kent General Hospital in Dover. Although we will attempt to honor specific patient requests regarding location and physician, depending on physician and hospital staff availability this will not always be possible.
Hemodialysis and Vascular Access
Hemodialysis is a way to clean a person's blood when the kidneys stop working. Hemodialysis requires access to a person's bloodstream in order to be effective. Reliable vascular access is critical to maintaining a healthy and uninterrupted dialysis schedule. The main types of hemodialysis access are fistulas, grafts, and hemodialysis catheters.
A fistula is a connection which is made by a surgeon between an artery and vein in a person's arm or leg. It is considered the best access because of a low risk of infection and often many years of reliable use.
A graft is an artificial tube that is placed by a surgeon under the skin in a person's arm or leg when a suitable vein is not available. Grafts have a low risk of infection but usually become worn out from use faster than fistulas.
Hemodialysis catheters are typically placed in the chest and can be used the same day. Dialysis catheters have the highest risk of infection, and usually stop working faster than fistulas or grafts.
Procedures Performed to Maintain Vascular Access
Although both fistulas and grafts can provide reliable access for many years, occasionally problems occur. Some fistulas do not mature completely, and the vein does not grow as large as is expected. A blockage, or stenosis can also occur in the fistula or graft that limits the blood flow and makes hemodialysis difficult to perform. Sometimes the access can clot and hemodialysis cannot be performed at all.
A fistulogram is done when there is a problem with the function of a fistula or graft. A small needle is placed into the access and X-ray dye is injected. X-ray pictures are the taken to see if there is a blockage in the access. If a blockage is identified, then the doctor can stretch the blockage with a balloon, called an angioplasty.
A declot is necessary when a person's vascular access has completely stopped working. The doctor will place two needles into the access to remove the clot and start the access flowing again. Since an access usually clots because a blockage has formed, frequently the doctor will also perform a balloon angioplasty during the same visit.
Hemodialysis catheter insertion is performed if a patient does not yet have a permanent vascular access in the arm or if the doctor cannot fix a vascular access that has stopped working. The doctor usually places the catheter into a vein in the chest and uses an X-ray camera to verify that the catheter is positioned properly.
Hemodialysis catheter exchange is performed when a person's catheter fails to function properly. The doctor will use X-ray dye and an X-ray camera to take pictures of the catheter and the vein to find out why the catheter is not working. A balloon angioplasty may be needed to break up scar tissue.
Hemodialysis catheter removal is performed when a person's permanent vascular access is working well, or if the patient no longer requires dialysis.
What to Expect From Your Procedure
Most patients only need injection of numbing medicine and do not require sedatives. We ask all patients to not eat or drink at least 6 hours before your procedure in the event you require sedation. Also, if you receive sedation medication, then you cannot drive yourself home. In that case, you are responsible for arranging your transportation home.
The Interventional Nephrologists at Nephrology Associates, P.A. do not perform the initial surgery to create a fistula or place a graft in the arm or leg. We can refer you to a surgeon with specific skills in this type of vascular access creation.
Address and Directions
1092
Old Churchman's Road
Newark,
DE 19713
(302)
472-9880
Directions from Wilmington and points north:
- I-95 South to Exit 4B (SR 7N/Stanton)
- Bear right after passing Delaware Tech College onto Rt 7 N (Stanton-Christiana Rd).
- Immediately move into left lane. At second light on Rt. 7, turn left onto DE-4 W (Ogletown-Stanton Rd)
- Travel 1/2 mile, then turn left onto Old Churchman's Rd.
- Turn left at the Rockford Center sign, then turn into the first parking lot on the left. Our parking lot is the second lot on the left.
From Newark and points South:
- Take I-95 North to Exit 4B Rt 7N (Metroform)
- Move into left lane. At second light, turn left onto DE-4 W(Ogletown-Stanton Rd)
- Travel 1/2 mile, then turn left onto Old Churchman's Rd.
- Turn left at the Rockford Center sign, then turn into the first parking lot on the left. Our parking lot is the second lot on the left.
From Dover:
- Take Rt 1 N past Christiana Mall, and Rt. 1 N becomes Rt 7 N
- Move into left lane after passing I-95 interchange. At second light, turn left onto DE-4 W(Ogletown-Stanton Rd)
- Follow remaining directions from Newark above beginning at Step 3