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Pt referred Chronic Hemodialysis (HD)

Hemodialysis (HD) Flow Chart. * Rules for Access Placement - Upper extremity > lower extremity - Nondominant extremity > dominant extremity - Nonpacemaker > pacemaker side - Distal > proximal - Superficial > deep vein (may need superficialization) - Diameter > 3 mm per U/S image .

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Pt referred Chronic Hemodialysis (HD)

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  1. Hemodialysis (HD) Flow Chart * Rules for Access Placement - Upper extremity > lower extremity - Nondominant extremity > dominant extremity - Nonpacemaker > pacemaker side - Distal > proximal - Superficial > deep vein (may need superficialization) - Diameter > 3 mm per U/S image Pt referred Chronic Hemodialysis (HD) No Does pt have potential living LD? Yes Pt on HD? Yes No Is Cr Cl >15? Yes No Life expectancy  6 months? Workup for LD renal tx No Is patient symptomatic? No • Consider superficialization • Ligation of collaterals Yes Yes Workup for chronic HD* Place Ash-Split catheter Start HD Ultrasound Yes No No Is fistula maturing? Continuous vein present? Yes Surgery for AVF AVF possible? • D/C Coumadin • Continue ASA & Plavix Yes No Surgery for PTFE graft

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