Can someone explain the fistulagram: What
does the procedure involve? How damaging is
it to the fistula? Is it painful?

I am the Vascular Access Coordinator in our unit and have a problem with fistulagrams. I use the Transonic system and some of the patients I have sent for fistulagrams have come back to report ‘they say there is nothing wrong with my fistula. These people are always the ones who have the thin walled AV fistulas. When you try to get any kind of blood flow the fistula collapses. When they do a fistulagram they inject contrast at whatever rate, they do not pull on the fistula. Fistulas don’t always work bad because of a stenoses. Sometimes they are just to soft to get the high blood flows.

Many times the accessory veins prohibit the flow of blood in the fistula when the lines are reversed.Remember the basics,LOOK LISTEN and FEEL.Check your URR and KT/V, Check your blood flows on the machine,check your needle placement.I am also A Vascular Access Coordinator for 650 patients and I have used th Crit-Line Monitor and The Transonics MACHINE..

I worked in dialysis for 7 years, and am now an Access Coordinator for a vascular access center. We do 3-4 fistulagrams every day. Simply stated here's what a fistulagram is: 1. access is numbed usually with Lidocaine subQ. 2. A needle is inserted into the access. 3. a guide wire is inserted into the needle. 4. the needle is pulled, leaving the wire in place. 5. a sheath (a straw-like object is placed into the access over the wire. 6. contrast media is injected through the sheath allowing the access to be seen under fluoroscopy (X-ray)....the worst part of the procedure is the sting of Lidocaine to numb the area. If angioplasty (balloon opening of narrow areas) is needed, a sedative is usually given to allieve pain/anxiety associated with that.
A fistulagram, if properly performed, will tell the examiner why the patient has a low transonic flow. In our facility, if there is any doubt, we have a flow meter which measures direct blood flow through the fistula using an insertable catheter through the sheath (Angioflow by Angiodynimcs).
As to the fistula that looked "good" but collapses during treatment, I would suspect that the patient has an arterial lesion which would disallow blood refilling into the fistula as you run the HD treatment. Many interventionalists do not address arterial lesions due to the risk of rupturing the access which would be cause of emergent surgery. If you read your fistulagram report, you should be able to note whether or not the arterial anastamosis was visualized. If it was not mentioned, it wasn't visualized, they would have put that in their report for it is another billable fee. If it wasn't addressed, demand to the pt's Nephrologist that another fistulagram be done with attention placed on the arterial end of the access.