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A fistulogram is a procedure to find or fix problems in your arteriovenous (AV) graft or fistula.
How to prepare for a fistulogram:
Your healthcare provider will talk to you about how to prepare for your procedure. He may tell you not to eat or drink anything after midnight on the day of your procedure. He will tell you what medicines to take or not take on the day of your procedure. You may need to stop taking blood thinners or aspirin several days before your procedure. You will be given contrast liquid during your procedure to help your blood vessels show up better in pictures. Tell your healthcare provider if you have ever had an allergic reaction to contrast liquid. Arrange for someone to drive you home after your procedure.
What will happen during a fistulogram:
- You may be given IV medicine to help you relax and local anesthesia to numb the area. With local anesthesia, you may still feel pressure or pushing during the procedure, but you should not feel any pain. Your healthcare provider will insert a catheter into your graft or fistula. He will inject contrast liquid through the catheter and take x-rays. You may feel warm or nauseous as the contrast liquid is injected. This is normal and should go away in a few minutes.
- Your healthcare provider may measure the blood flow or pressure in your graft or fistula. He may insert tools through the catheter and remove a blood clot or blockage. He may also widen the opening of the fistula or graft and place a stent. Your healthcare provider will remove the catheter when he is done. He will hold pressure over the area for several minutes. He may place a pressure bandage over the puncture site to help stop any bleeding.
What will happen after a fistulogram:
Healthcare providers will monitor you until you are awake. They will also monitor the puncture site for bleeding. You may be able to go home or you may need to spend a night in the hospital. You may get dialysis after your procedure. Your arm or leg may be sore, swollen, and bruised after the procedure. This is normal and should get better in a few days.
Risks of a fistulogram:
Your healthcare provider may not be able to fix problems that he finds in your graft or fistula. You may get an infection or bleed more than expected. Your blood vessels, graft, or fistula may be damaged during the procedure. You may get a blood clot in your limb, lung, heart, or brain. The contrast liquid may cause kidney failure or an allergic reaction. These problems may become life-threatening.
Call 911 for any of the following:
- You have any of the following signs of a heart attack:
- Squeezing, pressure, or pain in your chest that lasts longer than 5 minutes or returns
- Discomfort or pain in your back, neck, jaw, stomach, or arm
- Trouble breathing
- Nausea or vomiting
- Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing
- You have any of the following signs of a stroke:
- Numbness or drooping on one side of your face
- Weakness in an arm or leg
- Confusion or difficulty speaking
- Dizziness, a severe headache, or vision loss
- You feel lightheaded, short of breath, and have chest pain.
- You cough up blood.
- You have trouble breathing.
- You have bleeding that does not stop after 10 minutes of holding firm, direct pressure over the puncture site.
Seek care immediately if:
- Blood soaks through your bandage.
- Your hand or foot closest to the graft or fistula feels cold, painful, or numb.
- Your hand or foot closest to the graft or fistula is pale or blue.
- You have trouble moving your arm or leg closest to the graft or fistula.
- Your bruise suddenly gets bigger.
Contact your healthcare provider if:
- You have a fever or chills.
- Your puncture site is red, swollen, or draining pus.
- You have nausea or are vomiting.
- Your skin is itchy, swollen, or you have a rash.
- You cannot feel a thrill over your graft or fistula.
- You have questions or concerns about your condition or care.
You may need any of the following:
- Acetaminophen decreases pain. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not take more than 4 grams (4,000 milligrams) of acetaminophen in one day.
- Blood thinners help prevent blood clots. Examples of blood thinners include heparin and warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
- Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
- Tell your dentist and other healthcare providers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.
- Do not start or stop any medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
- Tell your healthcare provider right away if you forget to take the medicine, or if you take too much.
- Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin.
- Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
- You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
- Take your medicine as directed. Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Care for your wound as directed:
Remove the bandage in 4 to 6 hours or as directed. Wash the area once a day with soap and water. Gently pat the area dry.
- Apply firm, steady pressure to the puncture site if it bleeds. Use a clean gauze or towel to hold pressure for 10 to 15 minutes. Call 911 if you cannot stop the bleeding or the bleeding gets heavier.
- Feel for a thrill once a day or as directed. Place your index and second finger over your fistula or graft as directed. You should feel a vibration. The vibration means that blood is flowing through your graft or fistula correctly.
- Rest your arm or leg as directed. Do not lift anything heavier than 5 pounds or do strenuous activity for 24 hours.
- Prevent damage to your graft or fistula. Do not wear tight-fitting clothing over your graft or fistula. Do not wear tight jewelry on the arm or leg with the graft or fistula. Tell healthcare providers not to do, IVs, blood draws, and blood pressure readings in the arm with your graft or fistula. Do not allow flu shots or vaccinations in your arm with your graft or fistula.
Follow up with your healthcare provider as directed:
Write down your questions so you remember to ask them during your visits.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.