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The ABC’s of AV Fistulas

The ABC’s of AV Fistulas. Vascular Access. Team Up for Success : Developing your Skills. Things we can’t change . Patient Demographics Average Age Increasing Diabetes CVD PVD Hypertension. Late Referral . Coming to dialysis in urgent need No time to place & mature access

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The ABC’s of AV Fistulas

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  1. The ABC’s of AV Fistulas

  2. Vascular Access Team Up for Success : Developing your Skills

  3. Things we can’t change • Patient Demographics • Average Age Increasing • Diabetes • CVD • PVD • Hypertension

  4. Late Referral • Coming to dialysis in urgent need • No time to place & mature access • Catheters for immediate access • No Pre-ESRD teaching

  5. Surgical Placement • Pre- Surgical Assessment • Expertise of Surgeon • Understanding of long term use • Patient teaching

  6. Things we can change • Patient Teaching • Routine Access Physical Exam • Access Monitoring Program • Improving Cannulation Skills

  7. Patient Teaching • Initiate as early as possible • Diet • Exercise • Hygiene • Access Monitoring • What to do for complications

  8. Physical Exam • Inspection • Palpation • Auscultation

  9. Inspection • Skin color • Skin integrity • Edema • Drainage

  10. Palpation • Thrill • Temperature • Undulation

  11. Auscultation - Bruit • Changes in characteristics • Discontinuous • High Pitched

  12. Access Monitoring Program • Static Pressure Monitoring • Access Blood Flow Monitoring • Doppler Flow Studies • Recirculation Measurement • Kt/V or URR

  13. Complications

  14. Stenosis – Types of lesions • Arterial • Mid-Graft • Venous

  15. Venous Stenosis • High dialysis venous pressures • Trend increase in static venous pressures • Change in bruit • Prolonged post dialysis bleeding

  16. Mid-Graft Stenosis • Static arterial pressure increase • No change in venous pressure • Reduced access blood flow • Change in bruit

  17. Arterial Stenosis • Decrease in static arterial pressure • Decrease in access blood flow • Thrill reduced

  18. Thrombosis • Low blood flow in access • Hypotension • Stenosis • Excessive Hemostasis Pressure • Constriction on access

  19. Infection • Local • Systemic • From catheter infection • Clotted graft

  20. Aneurysms – AV Fistulas • “One site - itis” • Weakening in vessel • Skin thin and shiny • Risk of serious bleeding

  21. Pseudoaneurysms – AV Grafts • Cannulating in the same area • Wall of graft deteriorates • Potential for serious bleeding

  22. Steal Syndrome • Blood short circuits • Hand is deprived of blood flow • Pain • Cold • Cyanotic nailbeds

  23. Infiltration & Backwall Injury • Cannulation technique • Bevel down ? • Flipping ?

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