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This blog is a networking resource for ASDIN members. It is not intended to be utilized as legal or medical advice. ASDIN offers this blog as is, without any express or implied warranties, or other assurances as to the content of the material contained herein. ASDIN assumes no responsibility for errors or omissions contained herein, or for any actions taken or damages suffered by any person on the basis of, or in reliance upon, any of the information contained herein. Cases and images should ALWAYS be stripped of any/all patient-specific information (name, DOB, MR#, etc.). Cases should be well thought out and suitable for distribution. Language usage should be polite, collegial, and professional. If it is found that a participant is not using appropriate language, that participant’s comment may be blocked.


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Top tags: Policy and Procedure  tunneled dialysis catheter  central vein stenosis  articles of interest  Central Stents  Coding  policies  svc thrombus  accessory veins  accessory veins/ Coils  articles of interest; RESCUE  ASC  AVF  case  Consents  Conversion  Declot  Emergency  Great Stuff !!!!  HeRO  Online Survey  PD catheter PERITONEOGRAM  Pennsylvania  pericatheter thrombus  peritoneal dialysis catheters  report  Research  right IJ  SVC thrombus PE 

January 2018 Articles of Interest

Posted By Abigail Falk, Wednesday, January 24, 2018
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Advice on new C-arm purchase

Posted By Amy C. Dwyer, Tuesday, January 23, 2018

Esteemed colleagues,


My 10-year old Phillips BV Pulsera is wearing out and I am shopping for a new machine. I am looking at the Phillips Veradius Unity and the GE OEC Elite CFD (not the 9900 version). Does anyone have experience with either machine?



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Pennsylvania Help Wanted

Posted By Mary L. Nations, Friday, January 19, 2018

Wanted:  A Vascular Access Center in Pennsylvania that can share requirements or obstacles in licensing as an ASC Center with a fellow ASDIN member.


Direct email to if you are willing to connect.




Tags:  ASC  Conversion  Pennsylvania 

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CMS, Access Centers and AScs

Posted By Pierre J. Souraty, Wednesday, December 20, 2017

Do we have an idea about how many Extension of Practice have closed? (not switched to ASC)

Are there any information about the fact that CMS may pay FGM and access related procedures at EOP rates even if an access center went through the ASC certification? and what, as a Society are we planning to do about it?


Tags:  policies  Policy and Procedure 

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December 2017 Articles of Interest

Posted By Abigail Falk, Monday, December 18, 2017
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Emergency Consenting

Posted By Nephrology Associates PA Vascular Access Center, Wednesday, November 15, 2017

In the event we cannot get consent from a patient, their spouse, guardian or other legal entity, we have had the ordering physician, typically their dialysis Nephrologist that ordered the procedure, and the Interventional Nephrologist who is going to perform the procedure discuss the situation, decide it was in the patient's best interest to have the procedure performed and sign the consent.


I have looked online for emergency consent guidelines however most deal with blood transfusions, minors and don't relate to our situation.  I have found this verbage on several documents:


An emergency must meet all of the following criteria:

a) The patient's life or health must be in immediate and substantial danger.

b) The patient is incapable of consenting.

c) Any potential risks associated with the treatment are materially outweighed by the

potential benefits associated with treatment.


So my question is what do you do in these situations? 

How many signatures do you require on your consent forms if any?

Do you have any P&P's you would be willing to share?


Thank you in advance for your help,


Nicole Davis

Tags:  Consents  Emergency  Policy and Procedure 

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Suture Survey

Posted By Ramesh Soundararajan, Tuesday, November 14, 2017

Please complete the following quick online survey - click here


I will share summary report on blog.


Here is a preview of the survey questions below:


1) Do you routinely suture the entry site of access after intervention. Yes no

2) if so what is the material used a)proline b ethilon

3) when do you take it out a) waiting room b) next day

4) do dialysis units take them out for you. Yes  no 

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arm swelling after an AV graft

Posted By venkatesh rajkumar, Wednesday, November 8, 2017

hi all,

         This patient with ESRD had a left brachiocephalic vein stenosis (CTO) with upper limb edema ( there was no access on that side then). We did an angioplasty and stenting 8 months ago with complete resolution of edema. He was getting dialysis through a right sided jugular tunnelled catheter. Now that we wanted to create a permanent access for him ,went ahead and did a left brachio axillary graft. He developed arm and forearm swelling after that which is persisting and increasing. There was no sign of cellulitis. It has been a month now since creation of the graft and the swelling is still there and we have not used the graft yet .We did a venogram through the graft which looks normal without ant central stenosis/instent stenosis.I have attached the images of the graft vein junction, the central outflow and a short video of flow through the graft vein junction. What could be the reason for the swelling? How to proceed next? Inputs please...


Dr Venkatesh,


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Tags:  central vein stenosis 

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September 2017 Articles of Interest

Posted By Abigail Falk, Monday, September 25, 2017
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ASDIN Abstracts

Posted By Mary L. Nations, Monday, September 4, 2017

Click HERE for Abstracts from the American Society of Diagnostic and Interventional Nephrology, 13th Annual Scientific Meeting.​


REMINDER:  Deadline for ASDIN's Call for Abstracts for 14th Annual Scientific Meeting is 10/31/2017

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Tunneled Catheters

Posted By Joseph G. Abdallah, Tuesday, August 1, 2017

For catheter dependent patients: 

- Any data, guidelines or policies adopted by anyone regarding routine exchanges of TDC without an indication to prevent catheter getting stuck in central vessels/right atrium or wear of the catheter.

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2018 Medicare Fee schedule

Posted By Palam Annamalai, Wednesday, July 19, 2017
Has anyone plowed through the release of the 2018 Medicare fee schedule?  How does it affect the dialysis intervention codes?  

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Forearm Artery PTA/ Arthrectomy

Posted By Daniel V. Patel, Friday, July 7, 2017
Updated: Monday, July 10, 2017

Over the years I've come across several instances of steal, with significant forearm artery disease.  With high flow fistulae, usually we have reasonable results with banding.

The more challenging cases seem to be the lower flow fistulae, especially those with calcified forearm arteries.  We usually refer these for a DRIL/ proximalization of arterial inflow. 

The patient here presented with an ulceration at his 5th finger, consistent with distribution of flow from the ulnar artery.  Here, it appeared that the culprit was steal with the presence of a calcified ulnar artery.

I generally approach these cases with a full arteriogram, and address any clear, focal lesions with angioplasty.  However, I have been somewhat reluctant to pursue diffuse arterial calcification – with concerns for spasm/ trauma with angioplasty of extremely small vessels. 

Just wanted to see what some of your experiences are with these type of small arterial vessel issues.  Is anyone using arthrectomy on these types of cases?  Do any of you stent these lesions or pursue attempts at angioplasty with diffuse vascular disease?

Forearm arterial calcification seems similar to lower extremity peripheral arterial disease –and there have been significant advances with endovascular arterial arthrectomy and treatment of limb ischemia.  Are any of you employing these techniques in forearm arteries?

Danny Patel



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June 2017 Articles of Interest

Posted By Abigail Falk, Friday, June 23, 2017
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May 2017 Articles of Interest

Posted By Abigail Falk, Wednesday, May 24, 2017

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