Fistulogram Patient information leaflet (182kB pdf)
Introduction
We hope this guide will answer your questions about your fistulogram. Please contact the team if you require further information via the details at the end of this leaflet.
What is a fistulogram?
A fistulogram is a special x-ray procedure. It uses contrast medium (an iodine based solution otherwise known as X-ray dye). to look at the blood flow in your fistula or graft (dialysis access). This procedure can check to see if it is blocked or if there is any narrowing (stenosis).
Why do I need a fistulogram?
An arterio-venous fistula is the best means of access to the bloodstream for long-term haemodialysis. Your fistula or graft allows you to have effective dialysis. Your doctor feels that there may be a problem with your dialysis fistula (or graft), and this procedure is the best way to diagnose the problem associated with your fistula. You may already have had a Doppler ultrasound scan to assess the flow in your fistula.
Who will be doing the fistulogram?
A specially trained doctor called an interventional radiologist will carry out your procedure. They have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
What are the associated risks?
X-Ray radiation: All x-ray procedures involve exposure to radiation in varying amounts. The dose you get from a medical x-ray is very low and your doctor along with the radiologists have determined that the benefits of having the examination outweigh potential risks. The radiographer is present throughout your test making sure that the radiation dose is kept as low as reasonably possible and the duration and level of x-rays are kept to a minimum.
Contrast medium: A very small number of patients have an allergic reaction to the contrast medium (x-ray dye). This can be minor, severe, or even life threatening but the chances of this occurring are very rare. If you get an itchy rash or difficulty breathing during the procedure tell a member of staff, the team will provide appropriate treatment. Before your examination begins the radiographer will ask you a series of questions about your medical history, including any allergies you may have. This will help us assess if you are at risk of an allergic reaction to the x-ray dye.
Patients aged 12 to 55, could you be pregnant? X-rays can be harmful to an unborn
baby and should be avoided by patients who are or may be pregnant. It is recommended that the examination is performed within 10 days of the first day of your menstrual period. If your appointment is not within this time or if you think you may be pregnant, please contact the X-ray department before your appointment. When you arrive for your Angioplasty, you will be asked when your last period started. If it is more than 10 days earlier, your appointment may be postponed.
Breastfeeding: : No special precautions are required and you can carry on breastfeeding
as normal. However, if you have any concerns you may want to express some breast milk
prior to your appointment.
Preparing for your procedure
You may have some blood tests prior to the biopsy to check you do not have an increased risk of bleeding. If you are taking any blood thinning medications, like warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban or Clopidogrel, Ticagrelor you should inform your doctor before the procedure. You may be asked not to eat for four hours before the procedure, although you may still drink clear fluids such as water. Please contact the booking team before your appointment if:
- you are or think you may be pregnant
- you have had a previous allergic reaction to contrast medium (X-ray dye) or are allergic to iodine.
- you weigh over 30 stone/190 kilograms
- you plan on using hospital transport or need a hoist to transfer
- you require an interpreter – please inform us as soon as you receive your appointment letter, and we will arrange an interpreter for you
Please leave any jewellery or valuables at home.
If you are unsure or have questions about your preparation, contact your doctor or the X-ray department for advice.
Allergies
If you have any allergies you must inform your doctor. If you have previously reacted to contrast medium (the dye used for CT imaging) you must tell your doctor about this.
Medication
Please contact the radiology department if you are taking blood thinning medication (anti coagulants) such as Warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban or Clopidogrel, Ticagrelor. You may be asked to stop taking or be given alternative medication.
Getting to us
Once you have arrived at The Princess Alexandra Hospital (Hamstel Road, Harlow, Essex,
CM20 1QX), follow the signage to the radiology reception, which is located on the ground floor, green zone. Please let the radiology receptionist know that you have arrived for your appointment.
When should I arrive?
Please arrive in the radiology department at your given appointment time. A notification
through text or letter should have been sent to you to confirm this appointment.
Can someone stay with me in hospital?
You may have a friend or relative attend with you, but they will be asked to stay in
the waiting area while you have your procedure.
Children are not allowed in the waiting area unattended. Our staff are not permitted to
supervise children, so please ensure child care arrangements are in place to avoid your
tests being rescheduled.
The day of the procedure
You will be shown to a cubicle and asked to undress and put on a gown; please bring a dressing gown if you have one. You may also be asked to remove jewellery, dentures, glasses, or other metal objects, which may show up on the X-rays.
The procedure
Your identification will be checked by a nurse and radiographer, a brief history will be taken; please tell the radiologist what medication, severe allergies, choking episodes or other medical conditions, such as thyroid disease and diabetes you may have. Before the procedure, the interventional radiologist will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish. You will be asked to lie flat on your back on the X-ray table. The X-ray machine will be positioned above you. The skin over the area will be cleaned with a cold antiseptic skin preparation and you will be covered with sterile drapes. Local anaesthetic will be injected into the skin. A small incision will be made, a needle, a wire and finally a catheter (fine plastic tube) will be inserted into the blood vessel and guided to the correct position to obtain the images required for the fistulogram. You may be asked to hold your breath for a few seconds while the images are taken. If you have a fistuloplasty or venoplasty, you may have monitoring devices placed on your chest, arm and on your finger. Once the narrowing or blockage has been identified on the fistulogram, a balloon is inflated to open up the blood vessel and allow more blood to flow. Once the interventional radiologist is satisfied with the images, the catheter will be removed. Firm pressure will be applied to the skin entry point, for about ten minutes, to prevent any bleeding. Sometimes a stitch may be used. You will be advised at the end of the procedure about wound/dressing care. Your nurse, radiographer and radiologist will be with you the whole time during the procedure and will explain what is happening or what you need to do on the day. If you have any questions or concerns, it is OK to ask.
How long will this take?
The procedure will take about 15-20 minutes. You should be prepared to be in the department for up to an hour.
Is it uncomfortable?
It may sting a little when the local anaesthetic is injected. You may feel a warm sensation for a few seconds when the contrast medium is injected and feel like you are passing urine. Occasionally when the balloon is inflated during fistuloplasty/venoplasty, a dull ache may occur but this passes when the balloon is deflated.
After the procedure
Once the catheter has been removed the radiographer will show you back through to the changing area where you will be able to get dressed again. You will usually be able to go home after about 30 minutes. You may eat and drink as usual.
Can I drive after my procedure?
We recommend that you do not drive for twenty-four hours and you ask a friend or relative to drive you home following your procedure
How soon can I return to work?
We recommend you do not undertake strenuous activity and rest for the remainder of the
day.
What do I do if I feel unwell after I have gone home?
If you feel unwell after your procedure, you should seek medical advice from your GP/ hospital doctor or through the emergency department and inform them that you have had a procedure.
Follow up
The images will be studied by the radiologist (a doctor who uses x-rays to diagnose) and the results will be sent to the person who referred you for the examination. You will have a follow-up appointment with your doctor to discuss the results of your procedure.
Contacting the team
- If you have any further questions about your procedure or an existing appointment, please contact the radiology department (Monday to Friday, 9am to 4pm) at 01279 82 2527 or 3405
- If you have any queries outside of working hours (after 4pm and on weekends), you will be redirected to the main radiology reception. Please note appointment bookings cannot be made during this time.
Your feedback matters
- If you would like to give feedback on your care, please contact our patient experience team at [email protected] or01279 827211.
- Please contact the communications team at [email protected] if you would like this leaflet in another language or format.