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Interventional Nephrology Program
The Interventional Nephrology Program at Ochsner includes a percutaneous-access service directed by an interventional nephrologist and staffed by an additional nephrologist and a dedicated access nurse.
Our goal is to serve the needs of our patients through providing coordinated treatment.
Ochsner's Interventional Nephrology Program provides Hemodialysis Vascular Access (HDVA) care and performs the following procedures:
- Hemodialysis Tunnel catheter insertion, exchange, removal and repair
- Placement of temporary or permanent hemodialysis catheters
- Peritoneoscopic peritoneal dialysis catheter placement
- Bone biopsies
- Kidney biopsies
- Consultation for difficult access problems
- Angiogram of AV fistula and grafts
- Angioplasty of AV fistula and grafts
- Thrombectomy of AV fistula and grafts
- Endovascular stent placement of AV fistula and grafts
Results are followed closely by the Access Task Force, which has developed a computerized model to facilitate data acquisition.
Ochsner also performs routine, difficult and high-risk renal biopsy procedures under ultrasound, fluoroscopy or CT guidance. Transplant biopsies are routinely performed as well.
When it comes to laparoscopic peritoneal catheter placements, they’re scheduled as outpatient surgeries.
Outpatient bone biopsies, meanwhile, are offered for the evaluation of metabolic bone disease or renal osteodystrophy.
Fistulagrams are performed by injecting contrast through vascular access and monitoring the function of the fistula or graft. If there is any evidence of stenosis, we perform angioplasty any stent placement based on KDOQI guidelines.
A fistulagram is usually indicated for the following reasons:
- Difficult needle placement
- Persistently swollen arm
- Increased machine pressures
- Difficulty achieving hemostasis at the end of treatment
- Decreased blood pump speeds
- Decreased Kt/V or URR (due to recirculation)
- Clotting the system two or more times per month
- Sometimes stenosis of the downstream leads to a cascade of events resulting in thrombosis of the AV access. We perform endovascular removal of the thrombus burden from the arterial inflow and venous outflow.
Hemodialysis Central Venous Access Placement for Temporary Renal Replacement and Tunnel Dialysis Catheter Placement
- We perform placement of tunnel dialysis catheter for acute renal failures and also advanced chronic kidney disease patients prior to their Hemodialysis Vascular Access, such as AV fistula and graft, being established.