Examining Renal Access

Question 1

Examining an AV fistula - inspection

Answer 1

Inspection
Swelling ̄c surgical scar over distal forearm or @ elbow
Evidence of use: needle marks
Evidence of infection

Question 2

Palpation

Answer 2

Check if painful
Temperature
Palpable thrill

Question 3

Auscultate

Answer 3

Bruit

Question 4

Significant negatives

Answer 4

Evidence of infection
Stenosis
Aneurysm

Question 5

Definition of AV fistula
Name 2
What happens to the vein distally

Answer 5

Surgically created connection between artery and vein Radio-cephalic @ wrist = Cimino-Brescia
Brachio-cephalic @ the elbow
Venous limb (from machine) is proximal
Side-to-side anastomosis ̄c ligation of the distal vein

Question 6

Advantages of AV fistula

Answer 6

High flow rates, low recirculation (<10%)
Low infection rates
Less chance of stenosis cf. grafts

Question 7

Disadvantages of AV fistula

Answer 7

Take ~6 weeks to arterialise
Affect pts. body image
Must take care: avoid shaving, don’t take BP or blood from here

Question 8

Complications of AV fistula

Answer 8

Thrombosis and stenosis
Infection
Bleeding
Aneurysm

Question 9

What is steal syndrome

Answer 9

Distal tissue ischaemia
Pallor, pain, ↓ pulses
May → necrosis
↓ wrist:brachial pressure index

Question 10

Treatment of steal syndrome

Answer 10

Banding

Question 11

What is a tunnelled cuffed catheter

Answer 11

Tessio Lines

Two lines tunnelled under skin and entering IJV

Question 12

Disadvantages

Answer 12

May have ↑ recirculation cf. AVF Lower flow rates

↑ risk of infection and thrombosis

Question 13

Complications

Answer 13

May have ↑ recirculation cf. AVF
Lower flow rates
↑ risk of infection and thrombosis