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The Value of Physical Exam In Access Maintenance and Acquisition

The Value of Physical Exam In Access Maintenance and Acquisition. Carol M. Headley RN DNSc CNN Network 8 November 2006 Nashville, Tennessee. Physical Exam. Chest and Arms Uncovered Lying Supine Position Dominant Arm and Hand Determined Previous Surgeries Peripheral Vascular Disease

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The Value of Physical Exam In Access Maintenance and Acquisition

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  1. The Value of Physical Exam In Access Maintenance and Acquisition Carol M. Headley RN DNSc CNN Network 8 November 2006 Nashville, Tennessee

  2. Physical Exam • Chest and Arms Uncovered • Lying Supine Position • Dominant Arm and Hand Determined • Previous Surgeries • Peripheral Vascular Disease • Diabetic • IV Drug Abuse

  3. Size Does Matter 1.6 mm – Evidence 2.0 mm - Opinion

  4. Thrill Should Be Immediate

  5. Arterial Portion of Evaluation Pulse Examination – Roll Artery Segmental Blood Pressures Digital Pressures Allen Test Ultrasound

  6. Digital Pressures

  7. Steal Syndrome: Evidence Doppler Digital Pressures (mm Hg) Right Baseline Post Right Radial Artery Compression Thumb 45 94 Index 46 140 Middle 56 104 Ring 90 126 Small 88 118

  8. Steal Syndrome

  9. Venous Evaluation • Most Problems are Venous Related • Cephalic Vein is Optimal • Luminal Diameter 2.5 mm • Absence of Obstruction • Straight • Superficial • Continuity – Tap Test

  10. Beauty in Veins

  11. Early Failure: Accessory Veins

  12. Venous Stenosis: Not Obvious Initially

  13. Retrograde Flow

  14. Something Wrong?

  15. Threat is Real

  16. Emphasis is on Fistulas: So Why So Many Catheters?

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