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AV FISTULA EXAMINATION
Inspection
o Exposure – sleeveless
o Examine entire hand on area with fistula an draining veins all the way to central veins.
o General comments: Patient stable in no obvious distress
o Compare with other arm
o There are 2 swellings (aneurysms) – on inferior aspect of forearm etc etc. Size, site,
surface, mobility etc consistent with an AV fistula
o Veins
accessory & collateral visible
stenosis – bluish/purplish veins
o Scars
o Skin changes on access site
Inflammation signs: Erythema, rash, swelling
Infection: Drainage/Discharge, Abscess
Active bleeding
Thinning of skin overlying fistula
o Hands
Infection - warmth
assess for vascular steal syndrome (esp with fistula at elbow)
Ischemia
Numbness
Cold extremity
Ulceration
Pain
discolouration
o
Palpation
o From anastomosis to supraclavicular area and drainage area on chest for pulsations
o Use palmar aspect of hand or 3 to 4 fingers
o Pulses
In the body there should be little or pulse
If you press down too hard, you can induce an obstruction therefore feel lightly
No pulse – normal. If there is a pulse it implies downstream resistance
Thrill – normal - flow is good
o Thrill
Present: rate the thrill. Should decrease as you move further away from fistula
site
o Brisk, strong
o Weak, slow
QUESTIONS
1. What is an AV fistula
Surgically created anastomosis between an artery an a vein. The main use is to dilate a
vein so that it can be used for performing regular haemodialysis
2. Why is it needed
Blood volume that needs to be removed and returned during haemodialysis is too great
for a normal vein to cope with. Joining an artery and a vein allows the higher arterial
pressure to be transmitted to the vein causing:
o Dilatation
o Thickening of walls
o Increased blood flow through the vein
Once the vein is sufficiently dilated (matured), it is ready for dialysis
5. Advantages of an AV fistula
Lower infection rate than a Central venous catheter
Higher blood flow rate
Lower thrombosis incidence
6. Complications of AV fistula
Thrombosis
Infection – Staph aureus most common (patient, hospital staff), therefore hand hygiene
Aneurysm
Vascular steal syndrome – common in diabetics and people with elbow fistulae
Stenosis (venous)