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Reasons for Referral

1.) Currently have a dialysis catheter and need to have vessel mapping prior to surgery to place an arteriovenous access in the arm.

2.) Difficulty cannulation the access on dialysis.

3.) Maturation of a fistula should happen by 4-5 weeks after its creation. Lack of development of the proper size fistula might should prompt early intervention.

4.) Arm swelling/edema with or without bruising could be due to infiltration from cannulation on dialysis. Development of large aneurysms on the fistula or pseudoaneurysms on graft.

5.) Increased venous pressures on the dialysis machine

6.) Increased negative arterial pressure on the dialysis machine

7.) Yellow/Red light on the stop light (not green) during dialysis

8.) Low Kt/v or URR, which means poor clearances on dialysis

9.) Pain in the access arm or hand

10.) Prolonged bleeding at the needle cannulation sites

11.) Dialysis catheter not achieving blood flow of at least 300 ml/min

12.) Dialysis catheter infection

13.) Low access flow measurement (on the dialysis machine or transonic device) indicating an arteriovenous graft with access flow less than 600 ml/min

14.) Accessory flow of the fistula into side branches instead of the main fistula channel

15.) Pulling clots on dialysis tubing through needle

16.) Clotted access without anyflow through the access

17.) Abdominal pain and infection in abdomen requiring PD catheter reposition or removal, respectively.

18.) Need for initiating dialysis either with a PD or tunneled dialysis catheter. Due to lack of timely placement or development of AVF/G, some patients have to start dialysis on a dialysis catheter.

19.) Infection at the catheter insertion site also known as exit site, or in the track of the catheter, with or without positive blood cultures (bloodstream infection), needs catheter exchange or removal depending on severity of infection. Similarly, PD catheter related peritonitis (infection of the abdominal lining) may require catheter removal.