Week 11 - Dialysis Access Scanning

Question 1

What are 4 types of dialysis access?

Answer 1

Peritoneal Dialysis
Dialysis Catheter
AVF
AVG

Question 2

What is Peritoneal Dialysis and what is a complication?

Answer 2

Catheter in stomach, Dialysis each night or daily

Complication = infection

Question 3

What is a Dialysis Catheter and what is a complication?

Answer 3

Catheter into prox IJV, used for < 3 mo, venous blood out / cleansed blood into artery
Complication = infection

Question 4

Define a fistula

Answer 4

direct connection between artery and vein with one anastomosis

Question 5

What is the name of the fistula made between the radial artery and cephalic vein at the wrist?

Answer 5

Brescia-Cimino Fistula

Question 6

Define a Graft

Answer 6

2 anastomoses: arterial anastomosis and venous anastomosis with the graft between them
Transposed vein or PTFE

Question 7

Dialysis takes _______ pressure arterial blood out and puts blood back into _______ pressure vein.

Answer 7

high, low

Question 8

Name 4 AV graft configurations

Answer 8

• Forearm loop graft (Brachial artery to basilic or cephalic vein)
• Brachial to axillary graft
• Axillary loop graft
• Femoral loop graft

Question 9

Primary patency rates of ________ are better than ________.

Answer 9

AVF’s, AVG’s

Question 10

What is expected when doing a physical exam of a fistula?

Answer 10

Palpable thrill

Question 11

If the graft feels _________ with no thrill, may have an ____________.

Answer 11

pulsatile, obstruction

Question 12

What does it mean if the hand temperature on the access side is colder than the other hand?

Answer 12

AVF may be stealing blood from the hand

Question 13

What are some important things to remember when scanning an access site?

Answer 13

1. Scan the entire inflow artery
2. Scan the entire outflow vein to most proximal point
3. DO NOT take pressure over graft

Question 14

What three things should you document at each scan point?

Answer 14

Size, Depth, and Velocity

Question 15

What are the characteristics of a normal AVF flow pattern?

Answer 15

• Very Turbulent ( no turbulence in abnormal)
• Low Pulsatility (high is abnormal)
• Very low resistance (high is abn)
• High velocities near AVF that decrease with distal flow
• Change in Velocity with diameter change

Question 16

What is a common dialysis access problem?

Answer 16

Venous outflow stenosis (may be far distal to fistula)

Question 17

When you compress the AVF to test for AVF steal, the digital pressure should __________.

Answer 17

increase