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TREATMENTS › LIMB SALVAGE & PERIPHERAL

Keep Your Dialysis Access Working — Seen the Same Day if Possible

A failing or clotted access needs prompt care. You are seen the same day if possible or within two business days, based on your availability, and we treat and maintain your access in our outpatient lab. Dialysis already asks enough of you; keeping your access working, fast, is one less thing you should have to fight for.

What it is

Hemodialysis needs a way in and out of your bloodstream at high flow. That is the access: an arteriovenous fistula (an artery joined directly to a vein, which then enlarges and thickens over months), an arteriovenous graft (a synthetic tube bridging the two), or a tunneled catheter, which is the least durable and the one we work to get you off.
 

An access is a high-pressure system built out of a vein that was never designed for it. Over time it narrows, and eventually it clots. That is not a failure of your care. It is the natural history of the access, and the whole job is to stay ahead of it.

Why it matters

Data chart
24-48 hrs_Dialysis Access
Same Day_Dialysis Access

When a fistula or graft narrows or clots, every delay can mean a skipped dialysis session, a temporary catheter, or a hospital admission. Each catheter carries an infection risk that a fistula does not. We built our access program around speed: rapid scheduling, an outpatient setting, and direct coordination with your dialysis unit.

Dialysis Access

Risk Factors

Some accesses fail because of how they were built. Most fail because of where the vein narrows.
 

  • Graft rather than fistula — grafts clot more often and sooner

  • Diabetes; older age; small or previously injured veins

  • Repeated cannulation in the same spot, and cannulation technique

  • Low blood pressure, particularly at the end of a dialysis session

  • Central vein narrowing from a prior catheter or pacemaker lead on that side

  • Subclavian artery narrowing upstream, which can starve an access that looks locally normal →

Diagnostic Testing

  • Physical examination of the access — the thrill, the bruit, and how the arm behaves when you raise it. Still the most sensitive early test there is.

  • Dialysis-unit surveillance — rising venous pressures, falling flow, prolonged bleeding after needle removal, difficulty cannulating.

  • Duplex ultrasound of the access and the outflow veins.

  • Fistulogram — a detailed contrast picture of the whole circuit, from the artery through the central veins, done during the same procedure as treatment.

  • Access maturation assessment for a new fistula that is not developing.

Treatment options

Medical & conservative therapy

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  • Surveillance and early recognition — the access exam at every session.

  • Rotating cannulation sites; correcting technique.

  • Managing intradialytic hypotension.

  • Planning a fistula before dialysis is needed, so a catheter never becomes the default. Chronic kidney disease →
     

There is no medication that keeps an access open. Conservative care here means watching closely and acting early.

Invasive treatment

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  • Fistulogram — a detailed picture of your fistula or graft to find narrowing or clots.

  • Angioplasty & stenting — opening a narrowed segment, with a stent when the narrowing keeps returning.

  • Declot / thrombectomy — removing a clot to get a non-working access flowing again, the same day if possible.

  • Central vein evaluation and access maturation procedures
     

All outpatient, through a needle puncture, with same-day discharge.

When to reach out

  • Difficulty with needle placement, or your dialysis team reports trouble running treatment

  • Prolonged bleeding after needles are removed; a change in the "thrill" or sound over your access

  • Swelling of the arm, hand, or face on the access side; a clotted access or a fistula that isn't maturing
     

You don't have to wait for a scheduled visit. Access problems are time-sensitive, and we're set up to respond.

When to call us — don’t wait for your next visit

Your access needs attention fast when something changes. Check it every day — look, listen, and feel for the buzz. Call us right away if you notice any of these:

  • The buzz (thrill) or whooshing sound over your access weakens, changes pitch, or disappears — the most important sign of clotting

  • Bleeding from a needle site that takes longer than usual to stop, or prolonged bleeding after several sessions

  • New swelling of the access arm or hand

  • Redness, warmth, drainage, or pus at the access — possible infection

  • Fever or chills
     

Call our office at (918) 943-5303 and tell us what’s changed — we’ll get you seen sooner, because catching these early often keeps a small problem from becoming a big one.
 

Go to the emergency room now, or call 911, if you have:

  • A foot or leg that becomes suddenly cold, pale, numb, or painful

  • An infection that is spreading quickly, or a fever with a wound
     

A clotted access is time-critical — the sooner we see you, the better the chance of saving it. If the access is bleeding heavily and won’t stop with firm pressure, call 911 or go to the emergency room.

Frequently asked questions

For referring providers — We welcome direct referrals from dialysis center clinical managers, charge nurses, and nephrology teams. Access dysfunction and declots are seen the same day if possible or within two business days, based on the patient's availability. Refer: (918) 943-5303 · fax (855) 312-3594.
 

Refer urgently: a clotted or failing access — call us the same day it is found, for declot or salvage · Routinely: access dysfunction, difficult cannulation, prolonged bleeding, or a fistula that isn't maturing. Full referral guide →

Don't let an access problem wait.

Call us. You are seen the same day if possible or within two business days, based on your availability.

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