Dialysis Access: Getting it Right the First Time
News for Referring Physicians
To refer a patient for dialysis access placement to begin kidney dialysis, contact the transplant clinic at (608) 262-5420.
"Initiating dialysis isn't anything anyone wants to do," states Janet Bellingham, MD, , "but sometimes patients just need to be better prepared so they understand their dialysis access options."
The UW Health Comprehensive Dialysis Access Clinic creates fluid communication between patients, referring nephrologists, dialysis centers and the dialysis access team to focus on each patient and their own particular needs.
"It's important that patients get access before they require dialysis," says Dr. Bellingham, "and that they start with the type of access best suited to them."
Because no one access option will last forever and many patients have multiple conditions that complicate access, Dr. Bellingham is always thinking, "What might their next step be?"
She convenes a multi-discipline vascular access conference twice a month that includes Madison-area nephrologists, interventional nephrologists, vascular surgeons, dialysis center clinicians and transplant surgeons who perform dialysis access surgeries. They discuss trends, literature, treatment options and come to the table ready to share what they are seeing.
"Perhaps most important," says Dr. Bellingham, "is consistent messaging for patients. We want them to know how important it is to have appropriate dialysis access, and sometimes patients embrace that more when they hear it from more than one physician."
With that attention to detail, the clinic is staffed by people who are committed to the intricacies of dialysis access.
"You can't dabble in this rapidly changing field," adds Dr. Bellingham, "We have a robust, well-defined program that studies long-term outcomes and quickly applies the latest data to improve patient outcomes."
With a focus on streamlining patient care and the scheduling process, the clinic collects a robust amount of patient information prior to scheduling an appointment. Next, the patient's general health is assessed and a visual evaluation of the veins is completed.
Based on consensus on what the best standard of care is for each patient, the appropriate pre-op work may be completed that day or a venous mapping procedure may be scheduled. Once the best access placement option is determined, usually a fistula or graft, the procedure will be scheduled and performed in the operating room at UW Hospital. Nephrologists can refer their patients for arteriovenous fistula and arteriovenous graft planning and creation, including peritoneal dialysis catheter placement.
Dialysis Access Clinic services also include access maintenance. Ongoing care is provided by physicians with a vast amount of experience in dialysis access, including Dr. Bellingham and UW Health interventional nephrologists Micah Chan, MD, MPH and Alexander Yevzlin, MD.
Because interventional nephrology is a nascent discipline - it's been just eight years since interventional nephrologists began to practice in the U.S. - the team has a unique perspective on dialysis access care. The interventional nephrologists are committed to dialysis vascular access maintenance, including same-day correction of access dysfunction, returning patients rapidly to their dialysis unit.
Dialysis access evaluation appointments are typically scheduled within two weeks of the referral. The dialysis access placement procedure will ideally be scheduled within 30 days of the dialysis access evaluation appointment.