Physicians Area

Raleigh Access Center

Raleigh Access Center LogoCapital Nephrology Associates is pleased to provide modern hemodialysis vascular access care in a state-of-the-art outpatient facility. The access center is designed to provide timely procedural interventions on dialysis access in a convenient and comfortable setting. The facility is located on the first floor of Wake Plaza across the street from Wake Med Hospital on New Bern Ave in Raleigh, NC. Jeff Hoggard MD, our medical director, is credentialed in interventional nephrology procedures, is a board certified nephrologist, and has performed over 9000 interventional procedures.

Hemodialysis vascular access has been described as the “lifeline” of the dialysis patient.  At the Raleigh Access Center  our goal is to help create and protect this  lifeline.   This expert care is provided according to national guidelines and standards and is more expeditious and less costly than access care at the hospital.

Procedures performed at Raleigh Access Center

1. Declot or Thrombectomy –  This procedure removes the clot and re-establishes blood flow in the dialysis access.  A  clotted dialysis access cannot be used for hemodialysis until the access is declotted, and therefore,  we aim to perform this procedure as soon as the clotted access is discovered.

2. Angiogram/Fistulogram –  A contrast agent is injected through the graft or fistula to determine the cause of the blood flow problem. When a stenosis or narrowing  is  found, this procedure may  also require an angioplasty and/or a stent.

3. Angioplasty – A balloon catheter is inserted into  the graft or  fistula and inflated to dilate  a stenosis or narrowing.

4. Stent Placement – This involves placement of a metallic stent typically to help hold  open a blood vessel that continues to narrow after  an angioplasty.

5. Tunneled Dialysis Catheter Insertion –  A dialysis catheter is placed in one of the central veins in the neck or leg.

6. Tunneled Dialysis Catheter Exchange – Replacement of a catheter for a new or different type of catheter.

7. Tunneled Dialysis Catheter Removal – Removal of catheter when no longer needed.

8. Temporary Catheter Insertion – This dialysis  catheter is usually placed  in a central vein and is intended for less than one week of useage

9. Vessel Mapping –  Before surgery to create an arteriovenous access, vessel mapping  uses   ultrasound  and  venography to determine the artery and vein anatomy to best determine   what type of access surgery should be done and  where that access should  be created.

Common Reasons For  Referral to the Access Center.

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 cannulating the access

3.  Arm swelling

4.  Increased venous pressures on the dialysis machine

5.  Increased negative arterial pressure  on the dialysis machine

6.  Yellow light  on the stop light ( not green) during dialysis

7.  Low Kt/v  or URR which means  poor clearances on dialysis

8.  Pain in the access arm or hand

9.  Prolonged bleeding at the needle cannulation sites

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

11. Dialysis catheter infection

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

13. Low  access flow measurement ( on the dialysis machine or transonic device) indicating an arteriovenous fistula with access flows  less than 500 ml/min

Procedure Instructions

Your dialysis center or a staff member at one of our facilities will be able to assist you with specific instruction regarding preparation for your procedure.

1. In general there are no restrictions about taking medications prior to these procedures except for blood thinners or anti-platelet medications. Check with your Nephrologist to be sure it is safe for you to hold these medications and he/she may have specific instructions regarding other medications.

2. Notify our center prior to the procedure if you have an  allergy to latex and/or contrast (dye).

3. Moderate  intravenous sedation (“Conscious sedation”)  is used for many of our procedures to ensure patient comfort.   A local anesthetic is also used as well.

4. One should not consume food for 8 hours prior to receiving moderate sedation. It is very important for someone to drive you home after receiving sedation as you should not drive for 24 hours after the procedure.

5. These specific  written instructions will be given to you and reviewed with you by your dialysis center staff.  These instructions will also be reviewed with you  by phone from the access center.

Our Outcomes

There is strong evidence that early intervention to treat vascular access problems can reduce major complications. We believe it is important to:

• Provide timely and cost effective treatment of the ESRD patient.

• Minimize hospitalization related to access care for the ESRD patient.

• Provide a patient report to your doctor and dialysis facility in a timely manner.

• Provide patient education regarding access care.

Capital Nephrology Associates

Capital Nephrology Associates is a full service nephrology practice providing comprehensive state of the art diagnosis and treatment for kidney related diseases and hypertension. We also provide services for hemodialysis, peritoneal dialysis, renal transplantation referral, and followup. We have multiple locations, 10 physicians, 1 physician assistant and 5 nurse practitioners to serve you. Our physicians are on call 24 hours a day, 7 days a week and admit to all the major hospitals in the Wake area. Our Locations
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