When the kidneys lose the ability to adequately filter wastes and excess fluids from the body, which can occur from a variety of causes, the patient is considered to have End-Stage Renal Disease (ESRD). Patients with ESRD require the assistance of tunneled catheters or the creation of a fistula to receive dialysis treatments so that the blood can be filtered properly. Interventional Radiology (IR) plays a significant role in the placement of these lines, the mapping of the vessels for fistula creation, and the management and treatment of the complications associated with arteriovenous fistulas.

Understanding the complex nature of ESRD, the co-morbidities these patients often have, and the serious risks and negative outcomes that can occur from fistula interventions are essential for IR nurses.  Analyzing and preparing for each ESRD patient’s individual medical needs and planned interventions allows for better patient outcomes. 

This virtual presentation will discuss the pathophysiology of ESRD, the co-morbidities often associated with the disease, and the factors to consider when protocoling these patients for nursing sedation versus anesthesia-level care. Venograms, tunneled hemodialysis line placements, fistulograms, angioplasty, stenting, and de-clotting procedures will all be discussed. Complications and risks related to these procedures will be addressed utilizing case studies. Pictures of before and after images and video clips of upper extremity angiograms will be used to demonstrate altered perfusion and reperfusion. Nursing care considerations, medication administration, thrombolysis management, and potential complications will all be reviewed.