Pediatric Dialysis Fistula or Graft Intervention

Using live X-ray (fluoroscopy) for guidance, the doctor will insert a catheter (a tiny tube) into a vein or artery, usually in the arm or leg, and guide it to the fistula or graft.

Then one of three things will happen:

• For a narrowing, your child's doctor will thread a small, deflated balloon through the catheter into the narrowing and then slowly inflate the balloon to widen the narrowing. Sometimes more than one balloon is used.
• For a blood clot, the catheter will be connected to a small machine that sprays a saline solution onto the clot to break it up, and then suctions out the pieces of the clot. The procedure may need to be repeated.
• For a collateral blood vessel, the doctor will thread a tiny metal coil through the catheter and place it in the vessel. This will block blood from flowing into the collateral blood vessel, restoring the full flow of blood into the graft or fistula. Sometimes more than one coil is placed.

No. We will administer sedating medications so that your child is asleep during the entire procedure.

Your child will not feel pain during the procedure but some patients may feel discomfort around the tube insertion site for a few days following the procedure.

A typical fistula or graft intervention takes about one to two hours but may take longer. Some children may need to arrive many hours before the procedure to have certain lab tests performed, which will be clearly communicated to you.

The procedure is considered low-risk. However, potential complications include:

• Bleeding
• Infection
• Injury to the artery and/or vein
• Contrast reaction (allergic reaction to X-ray dye)
• Pulmonary embolus (blood clot in the lung)

We encourage good communication between you and your child, including the necessity and overview of the procedure as well as ensuring them that you are close by the whole time. Holding them or their hands until they leave for the procedure is a great way to provide support.

You will be given specific instructions along the way but you may need to arrive a few hours before the scheduled procedure to have some blood tests done. When you arrive at the hospital, a doctor will review the procedure and associated risks, after which you will sign a consent form. When we are ready to get started with the procedure, a nurse will place an intravenous line to deliver sedating medications and you will be allowed to accompany your child in the operating room until they are asleep, after which you will be escorted to a waiting room.

Your child will be taken to a recovery room and in some cases may be admitted to the hospital for observation. Your child might have some mild discomfort; you may give over-the-counter pain medication if permitted by your primary physician.

The bandage must stay dry and in place for 48 hours. You may sponge-bathe your child during this time, as long as the bandage stays dry. After 48 hours you may remove the clear bandage and gauze and your child can take a shower or take a bath, as long as the site isn’t immersed in water. Leave the Steri-Strips® (white strips) in place. Do not immerse the site in water until the Steri-Strips fall off. If they haven’t fallen off after seven days, you may remove them.

Your child may return to normal activity as tolerated.

• Redness, pain, swelling or bruising at the needle insertion site.
• Fever higher than 101° Fahrenheit or 38° Celsius.
• A change in color or temperature to the associated extremity.
• Numbness, swelling or pain of the associated extremity.
• The Department of Interventional Radiology can be reached at: 202-476-3791, Monday through Friday, between 8 a.m. and 5 p.m.

At all other times please call 202-259-8643, which is the on-call pager. Follow the instructions and wait for a call back.