Renal

Question 1

How do you examine an AV fistula?

Answer 1

Inspect:

1. Location: radiocephalic, brachiocephalic or brachiobasilic
2. Check both arms for previous fistulae
3. Evidence of recent use: needle marks or dressings
4. Signs of aneurysms, haematomas or infection - e.g. rash
5. Swelling of fistula arm or the collateral veins - indicating central vein stenosis
6. Cold/blue hands distal to fistula - steak syndrome

Palpate:

1. For a thrill
2. For any pulsatility (fistula outflow problem)

Listen over fistula for a bruit