With ultrasound imaging, a handheld device is passed lightly over the skin above your blood vessels. Sound waves are used to create pictures of your arteries and veins.

A venogram involves injecting iodine contrast (X-ray dye)  into the veins of the extremity where your access will be placed. The X-ray dye allows the vessels to be imaged and evaluated as needed.

Through the use of ultrasound and/or venography, the North Shepherd Vascular Access Center physician will be able to see your vessels, identifying the ideal location for access creation. Normally, patients experience minimal to no discomfort during either of these procedures. The results will be shared with your referring physician.

Purpose:  To ensure your catheter is placed properly, functioning optimally and removed timely.

What You Need to Know
There are four basic types of catheter-related procedures performed at North Shepherd Vascular Access Center:

New Catheter Placement
In order to place a new catheter for dialysis, the North Shepherd Vascular Access Center physician will evaluate you using ultrasound and or X-ray dye to determine the most appropriate site to have your catheter placed. Using sterile technique, the best catheter will be inserted to allow for optimal dialysis. Sutures will be placed to secure the catheter. You will be given instructions prior to discharge from the North Shepherd Vascular Access Center care team on how to care for your catheter.

Catheter removal is a procedure to safely extract a catheter that was previously inserted for medical treatment. This process is essential to prevent potential complications such as infections or blockages. Our skilled medical team ensures that catheter removals are performed with utmost care, minimizing discomfort and promoting swift recovery.

There are some patients that are suitable for percutaneous fistula creation, which means creating a new fistula without surgery.  This method is less invasive than traditional surgical fistulas and has less pain and scarring.  We offer this type of new access creation at North Shepherd Vascular Access Center.

During this procedure, a vascular specialist will use ultrasound guidance to create a small puncture into the skin and into a superficial vein. The physician then inserts a wire that is advanced distally (toward the direction of your hand) until the wire passes through the superficial vein and punctures the wall of the radial artery.

Next, a sheath is temporarily placed between the vein and artery as the wire is removed and a special catheter is inserted. The catheter then pulls the walls of the vein and artery together, while thermal energy is then activated to finalize the connection.

The entire procedure takes approximately 30 minutes.  After about 2 hours, you will leave with a small band aid.

Whether your catheter is not functioning properly or your catheter is believed to be infected, your catheter may need to be exchanged. If so, a local anesthetic will be used to numb the tissue around the site where the catheter exits your body. If you desire, IV medication can also be used to allow for greater sedation and pain control.

During the catheter exchange procedure, the blood vessel where the catheter lives will be evaluated using X-ray dye, as sometimes tissue known as “fibrin sheath” can grow around the catheter causing the catheter to malfunction. If this is the reason for your catheter to fail, during the exchange procedure the tissue may be broken apart, typically using an angioplasty balloon.

A new catheter will then be inserted through your current catheter track, exiting the body in the same location as the old catheter did. The new catheter will be secured in place with a suture and instructions will be provided to you on how to care for your catheter prior to discharge.

You are encouraged to remind your dialysis care team of your recent procedure, as they may want to reduce the amount of heparin used during your next treatment.

Before you can begin peritoneal dialysis (PD) treatments, you need to have a peritoneal dialysis catheter placed as an access for the removal of waste and toxins from your body.  A PD catheter, the only type of dialysis access used for PD, is placed through your abdomen and into the peritoneal space through the peritoneal membrane—the thin membrane that lines your abdominal wall.

Percutaneous catheter placement is performed using fluoroscopy—an imaging technique that uses X-rays to help your vascular specialist view the inside of your abdomen.  This procedure requires only local anesthesia and sedation.

Your vascular specialist begins by using a fine needle to make a series of small punctures in your skin to access the peritoneum.  The PD catheter is then passed through a small tunnel in your belly into the peritoneum and secured in place.

After the PD catheter has been inserted, your vascular specialist will place sutures around the catheter on the outside of your abdomen and cover the site with a sterile dressing.  PD catheter placement can usually be performed in under one hour. However, you may spend additional time in the recovery room before going home so your vascular access team can monitor you. The access center can also repair, replace, and remove an existing PD Catheter