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dialysis access

Femoral versus Jugular, part two

I have always been told that the jugular veins are preferable over the femoral veins when inserting temporary dialysis catheters. Various reasons are put forward for this including increased risk of infection and poor function of femoral catheters…

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Achilles heel of dialysis

Vascular access is the Achilles tendon of hemodialysis. Just yesterday, I saw a patient with one of those lumbar catheters… Examining his arm revealed that he had failed 4 attempts of access creation (2 fistulas and 2 grafts)….

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Vas-cath exposure variability

How many vas-caths did you (the renal fellow) place during your clinical year (1 year)? Poll results: 0-5 (IR does most of these) 4 (4%) 0-5 (Surgery does most of these) 2 (2%) 0-5 (IM residents do most…

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Ultrasound guided vas-cath placement

Much of the clinical year of the renal fellow is spent in the hospital rounding on patients admitted with access malfunction, catheter related infections or are in the ICU’s with acute kidney injury. Many of these patients will…

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Angiojet as a Cause of AKI??

The Angiojet Rheolytic Thrombectomy System is a medical device currently used to re-establish blood flow in a variety of settings. Briefly, a catheter is introduced into an area of thrombosis and a saline stream is directed towards the thrombus of…

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Poll Results & Post-Boards Weariness

First things first:  last week’s poll results showed that the majority of individuals were wary of using physician “Pay For Performance” as a strategy towards increasing AV fistula placement rates.  Proponents of this strategy (see editorial by Hakim…

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Preop Vascular Mapping for AVF/AVG

Current KDOQI Guidelines recommend the use of some type of vascular mapping studies in order to prepare for the creation of an AV fistula or an AV graft. While physical exam is useful–typically, application of a tourniquet around…

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Secondary AV Fistulas

Since I’m presently trying to make it through the most recent ish of NephSAP–their first-ever issue of “Interventional Nephrology”–I’ll do another access-related post. A “secondary AV fistula” refers to a fistula created after a pre-existing graft or fistula…

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