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What is Dialysis?

Dialysis allows people with kidney failure (renal failure) a chance to live productive lives. When kidney function decreases to a critical level or complications arise, a person may need to start dialysis. There are two main types of dialysis, hemodialysis and peritoneal dialysis.

Dialysis Access Center

Our Dialysis Access Centers is committed to providing you with the latest in state of the art imaging, diagnostic and interventional services, and education to meet your dialysis access needs.

We established a Dialysis Access Center to provide prompt, state-of-the-art care to patients who need to have a dialysis access created or repaired before undergoing or continuing hemodialysis or peritoneal dialysis.

We offer the following ways to establish and maintain your dialysis access.

Permacath (CPT 36569)

What is permacath?

A permacath is a piece of plastic tubing that is similar to a jugular catheter. It is used for hemodialysis in the exact same way that a jugular catheter is used. The advantage of the permacath is that it can provide access to the vascular system for up to one year. This is important for dialysis patients because they will avoid multiple catheter insertions, which could eventually lead to vein damage.

How does the procedure work?

Using an X-Ray machine and small surgical tools, the surgeon places the permacath in the jugular vein. The permacath is moved under the skin throughout the upper chest, under the collarbone, and the end of the catheter comes out on the chest wall. The X-Ray is used in order for the surgeon to follow the path of the catheter throughout the procedure and make sure it is placed correctly.

Watch this short video to find out more about the Permacath!
https://www.youtube.com/results?search_query=permacath

How much does the procedure cost?

$3,800*.

This is a self pay, all inclusive price. Price will vary based on insurance and health status, use of additional resources and so on. We offer financing options for qualified customers.

The cost not only includes the price of the product, but more importantly, the skill and expertise of the specialist or healthcare professional that is doing the procedure. Look for someone who is licensed and trained and has experience treating patients using this procedure. Enroll in the SurgiCare Rewards Program to save money on treatments.

Are there any risks associated with this procedure?

Risks include puncturing the lung, bleeding, and infection.

Peritoneal Dialysis Access (CPT 49420)

What is peritoneal dialysis and how does it work?

Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Doctors call this lining the peritoneum. A doctor will place a soft tube, called a catheter, in your belly a few weeks before you start treatment.
When someone chooses to do peritoneal dialysis at home, they will consult with their doctor about which type of PD they will perform: Continuous ambulatory peritoneal dialysis (CAPD), which is done manually without a machine. Automated peritoneal dialysis (APD), which is done with a machine called a cycler.

What is the advantage of peritoneal dialysis over hemodialysis?

Hemodialysis Compared to Peritoneal Dialysis. Hemodialysis and peritoneal dialysis are both used to treat kidney failure. … Peritoneal dialysis uses the lining of the abdominal cavity (peritoneal membrane) and a solution (dialysate) to remove wastes and extra fluid from the body.

What is the most common complication of peritoneal dialysis?

The most common complications from peritoneal dialysis include infection around the catheter site or infection of the lining of the abdominal wall (peritonitis). Less commonly, there may be problems related to the catheter.

How much does the procedure cost?

$5,500*.

This is a self pay, all inclusive price. Price will vary based on insurance and health status, use of additional resources and so on. We offer financing options for qualified customers.

Need more information?

https://www.kidney.org/atoz/content/peritoneal

AV Fistula Angioplasty and Stenting

Dialysis fistula/graft declotting interventions improve blood flow in fistula and grafts – artificial blood vessel connections used to facilitate kidney dialysis, a treatment that uses a special machine to remove waste materials from the body. These connections can clog or narrow and require angioplasty and vascular stenting or catheter-directed thrombolysis.

What are Dialysis and Fistula/Graft Declotting and Interventions?

Dialysis fistula/graft declotting and interventions are minimally invasive procedures performed to improve or restore blood flow in the fistula and grafts placed in the blood vessels of dialysis patients.

Dialysis is a process used to treat patients whose kidneys are not working properly. It involves a special machine and tubing that removes blood from the body, cleanses it of waste and extra fluid and then returns it back to the body.

In order for a person to undergo dialysis, a physician first creates access to his or her blood vessel using one of three methods:

  • a fistula, which is made by joining together an artery and vein to make a bigger high-flow blood vessel.
  • a graft, in which a soft plastic tube is placed between an artery and a vein, creating an artificial high-flow blood vessel.
  • catheter access, in which a narrow plastic tube is inserted into a large vein in the neck or groin.

What are some common uses of the procedure?

These procedures are used to treat:

  • narrowing of dialysis fistula or grafts.
  • Blood clot

What does the equipment look like?

In these procedures, x-ray imaging equipment, a balloon catheter, catheter, guide wire, sheath, stent and a medical device that breaks up or dissolves blood clots may be used.

How does the procedure work?

Angioplasty and vascular stenting: Using imaging guidance, an inflatable balloon mounted at the tip of a catheter is inserted through the skin into the fistula or graft and advanced to the blockage. There, the balloon is inflated and deflated. In this process, the balloon expands the vein or artery wall, increasing blood flow through the fistula or graft. A stent may be placed to hold the vessel open.

Catheter-directed thrombectomy or thrombolysis: Using x-ray guidance and a contrast material that helps show the blood vessel, your interventional radiologist will insert a catheter through the skin into a vessel (artery or vein) and direct it to the thrombosis, or blockage. The blood clot will then be dissolved in one of two ways:

  • by delivering medication directly to the blood clot (thrombolysis).
  • by positioning a mechanical device at the site to break up the clot (thrombectomy).

What are the benefits vs. risks?

Benefits

  • No surgical incision is needed—only a small nick in the skin that does not have to be stitched.

Angioplasty and Vascular Stenting:

  • These procedures are performed using local anesthesia; no general anesthetic is required in the majority of patients.
  • You will be able to return to your normal activities shortly after the procedure.

Catheter-directed Thrombolysis:

  • Catheter-directed thrombolysis can greatly improve blood flow and reduce or eliminate the related symptoms and effects without the need for more invasive surgery.
  • Thrombolysis is a safe, highly effective way of re-establishing circulation blocked by a clot.
  • Thrombolysis is less invasive than conventional open surgery to remove clots and the hospital stay is relatively brief. Blood loss is less than with traditional surgical treatment and there is no obvious surgical incision.

Risks

  • Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
  • There is a very slight risk of an allergic reaction if contrast material is injected.
  • Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. However precaution is taken to mitigate these risks.

What are the limitations of Dialysis and Fistula/Graft Declotting and Interventions?

Some blockages of the veins or arteries are too difficult to open with catheters and balloons. Surgery may be needed to bypass the blockage. If that is the case, a dialysis catheter may need to be placed in a neck vein to allow you to receive dialysis temporarily until a surgeon is able to fix or revise your dialysis fistula or graft.

How much does the procedure cost?

$6,500*.

This is a self pay, all inclusive price. Price will vary based on insurance and health status, use of additional resources and so on. We offer financing options for qualified customers.

The cost not only includes the price of the product, but more importantly, the skill and expertise of the specialist or healthcare professional that is doing the procedure. Look for someone who is licensed and trained and has experience treating patients using this procedure. Enroll in the SurgiCare Rewards Program to save money on treatments.

Are there any risks associated with this procedure?

Risks associated with this procedure include bleeding, failure or closure of the fistula.

Need more information?
https://www.kidney.org/atoz/content/dialysisinfo

What is a PICC line?

A PICC is a long, thin, flexible IV line or catheter. It is placed in a vein in your arm and guided up into a larger vein near your heart. A PICC can have one or more openings called lumens. It may stay in for several weeks or months.

A PICC can be put in when IV medicines or fluids irritate smaller veins in the arms or hands. A PICC can be used to give IV medicines or fluids. Antibiotics, chemotherapy, blood products, IV nutrition and other IV medicines can be given through a PICC. Blood can also be drawn from a PICC for blood tests.

How is a PICC placed?

A PICC can be put in in the surgery center.
You will need to lay flat and keep your arm straight when the catheter is being placed.

  • Your arm will be cleaned and covered with a sterile cloth to prevent infection.
  • A numbing medicine is used to decrease discomfort where the PICC will be placed. Numbing medicine is given using a small needle injection into the top layers of your skin.
  • The PICC will be placed into a vein in your arm with a special type of needle. An ultrasound machine may be used to see the veins in your arm.
  • Once the PICC is placed in the vein, it is guided up into a larger vein near your heart.
  • You may be asked you to turn your head or move your arm and wrist. This helps the PICC move through the vein to the correct position.
  • After the PICC is in place, it is secured with an anchor device and a sterile dressing will be put on the area.
  • A chest x-ray may be done to check the position of the PICC.

Activity Limits with Your PICC

After the PICC is placed, you will need to limit some of your activities:

  • Do not do activities with repetitive motion such as golfing, tennis or pushing a vacuum that could cause the catheter to move.
  • You may take showers with the catheter in place. Cover the PICC catheter site with plastic wrap and tape it down. This keeps the dressing and the area dry.
  • Do not swim or do activities that can cause your arm with the PICC to be in water. This will loosen the PICC dressing and increase the risk for infection.

PICC Care at Home

  • Your PICC will need special care to keep it clean and working well. This includes: changing the dressing, flushing the lumen(s) and changing the lumen(s) cap.
  • Because the PICC is in your arm, you will not be able to do the special care needed for your PICC. PICC care may be done by your caregiver or nurse. Your nurse will work with you and your family to teach you how to care for the PICC.

How much does the procedure cost?

$3,500*.

This is a self pay, all inclusive price. Price will vary based on insurance and health status, use of additional resources and so on. We offer financing options for qualified customers.

What is a Mediport (Port-a-Cath)?

An implanted venous access port, also called a subcutaneous access port, mediport or power port, is a special type of intravenous (IV) device that is implanted (inserted) under your skin.

A common area a port may be put in is the upper chest. Ports can also be placed in an arm or the abdomen. Infusion ports come in different shapes and sizes. The type of port and the way it is used depend on your needs.

Implanted ports may be used for:

  • Chemotherapy treatment
  • Taking blood samples
  • Blood transfusions
  • Giving IV fluids and IV medicines

An implanted port has two parts: the “port” and the “catheter”.

How is a port put in?

A port can be put in by a doctor in the surgery center. An IV line will be placed in your arm and you will be given medicine to help you relax.

Two small incisions will be made during the procedure: One incision will be made near the bottom of your neck above your collarbone. A second incision will be made on your upper chest. This is where the port will be placed under your skin. A tunnel is then made under your skin between the two incisions. The catheter is connected to the port, pulled through the tunnel and placed into a large vein just above your heart. The incisions are closed and held together by stitches, special surgical glue or steri-strips (small tapes). Both incisions are covered with a small gauze dressing. You may feel and see a raised area on your chest where the port has been placed.

How to Care for Your Incisions

  • Your incisions should heal in about 7 to 10 days.
  • You may shower 1 to 2 days after your port was placed.

What to Expect After a Port is Put In

  • You may have some bruising, swelling and tenderness where the port was put in.
  • These symptoms should go away after 1 to 2 days.
  • You may have some mild discomfort in the area where the port was placed. Talk to your doctor about what you can do to help with any pain or soreness.

Activity Guidelines

After a Port is Put In For about 2 weeks after your port is placed, you will need to hold off (limit) some activities while your incisions are healing.

Here are precautions you will need to follow.

  • Do not do any strenuous exercises.
  • Do not do activities or exercises that involve reaching or stretching your chest and neck areas.
  • Do not lift anything heavier than 10 pounds (a gallon of milk is about 8lbs).

Note: Do not play contact sports while you have a port.

Care and Use of Your Port

A port can stay in place as long as you need it and it is working well. This can be for several months to a year or longer provided its flushed every few weeks.

We use BARD PowerPort – low profile, safe, proven track record and MRI compatible

How much does the procedure cost?

$4,500*.
This is a self pay, all inclusive price. Price will vary based on insurance and health status, use of additional resources and so on. We offer financing options for qualified customers.