💥’Physical Examination of the Dialysis Vascular Access’ - Tweetorial
Let’s first review the:
⚡️Anatomy of the Vascular Access
⚡️Vascular Access-related
complications
1/
@ASDINNews
@RenalFellowNtwk
#VascularAccessPearls
Let’s first review the:
⚡️Anatomy of the Vascular Access
⚡️Vascular Access-related
complications
1/
@ASDINNews
@RenalFellowNtwk
#VascularAccessPearls
💥 A dialysis vascular access is a ‘circuit’ and NOT just a ‘connection’ between an artery & a vein
⚡️The circuit consists of:
☄️ Pump (heart)
☄️ Inflow (artery)
☄️ Conduit (body of the access)
☄️ Outflow (vein)
2/
⚡️The circuit consists of:
☄️ Pump (heart)
☄️ Inflow (artery)
☄️ Conduit (body of the access)
☄️ Outflow (vein)
2/
💥 There are 3 basic types of vascular access:
⚡️AVF (arterio-venous fistula)
⚡️AVG (arterio-venous graft)
⚡️CVC (central venous catheter)
☄️AVF: created by a direct connection b/w an artery & a vein
☄️AVG: graft is interposed b/w an artery & a vein👇🏽
3/
⚡️AVF (arterio-venous fistula)
⚡️AVG (arterio-venous graft)
⚡️CVC (central venous catheter)
☄️AVF: created by a direct connection b/w an artery & a vein
☄️AVG: graft is interposed b/w an artery & a vein👇🏽
3/
💥 Dialysis Vascular Examination includes:
⚡️Inspection
⚡️Palpation
⚡️Auscultation
☄️Vascular access examination is not only used to detect stenosis, but it is also used to assess several access-related complications
4/
⚡️Inspection
⚡️Palpation
⚡️Auscultation
☄️Vascular access examination is not only used to detect stenosis, but it is also used to assess several access-related complications
4/
💥 Inspection
⚡️Assess:
☄️AV access length & diameter
☄️Aneurysm
☄️Infection
☄️Arm swelling
☄️Cyanotic hand, gangrene
5/
⚡️Assess:
☄️AV access length & diameter
☄️Aneurysm
☄️Infection
☄️Arm swelling
☄️Cyanotic hand, gangrene
5/
💥 Assess the AV access location, length & depth
⚡️These factors determine if an AV access can be cannulated successfully or not👇🏽
6/
⚡️These factors determine if an AV access can be cannulated successfully or not👇🏽
6/
💥 AV Access Aneurysm
⚡️AVFs can form aneurysms & pseudo-aneurysms👇🏽
⚡️AVGs only form pseudo-aneurysms as they lack the true vascular wall
⚡️A pseudo-aneurysm is essentially a hematoma communicating with the AV access lumen👇🏽
7/
⚡️AVFs can form aneurysms & pseudo-aneurysms👇🏽
⚡️AVGs only form pseudo-aneurysms as they lack the true vascular wall
⚡️A pseudo-aneurysm is essentially a hematoma communicating with the AV access lumen👇🏽
7/
💥AV Access Aneurysm
⚡️Can be caused by ⬆️ access flow, ⬆️ intra-access pressure (stenosis) or repeated cannulation at the same site
⚡️Hence, it is very important to rotate the cannulation sites!
⚡️Surgical intervention for aneurysm depends on👇🏽
8/
⚡️Can be caused by ⬆️ access flow, ⬆️ intra-access pressure (stenosis) or repeated cannulation at the same site
⚡️Hence, it is very important to rotate the cannulation sites!
⚡️Surgical intervention for aneurysm depends on👇🏽
8/
💥AV Access Infection
⚡️It can be superficial or deep
⚡️Avoid cannulation at or near the infected site
⚡️Superficial Infections can be treated with antibiotics alone, but deep infections require surgical intervention👇🏽
9/
⚡️It can be superficial or deep
⚡️Avoid cannulation at or near the infected site
⚡️Superficial Infections can be treated with antibiotics alone, but deep infections require surgical intervention👇🏽
9/
💥 Arm Swelling
⚡️Indicative of central vein stenosis
⚡️Presence of collateral veins & cardiac devices points toward central vein stenosis👇🏽
10/
⚡️Indicative of central vein stenosis
⚡️Presence of collateral veins & cardiac devices points toward central vein stenosis👇🏽
10/
💥 Cyanotic hand, gangrene
⚡️Seen in dialysis access-related steal symdrome (DASS)
⚡️DASS pathogenesis👇🏽
⚡️Indications for surgical intervention for DASS depends on the severity of symptoms & the risk of tissue loss👇🏽
11/
⚡️Seen in dialysis access-related steal symdrome (DASS)
⚡️DASS pathogenesis👇🏽
⚡️Indications for surgical intervention for DASS depends on the severity of symptoms & the risk of tissue loss👇🏽
11/
💥Palpation & Auscultation are used to identify stenosis in the vascular access
⚡️Stenosis can be:
☄️Outflow stenosis: involves the outflow veins
☄️Inflow stenosis: involves the artery or the arterial anastomosis or the juxta-anastomosis👇🏽
12/
⚡️Stenosis can be:
☄️Outflow stenosis: involves the outflow veins
☄️Inflow stenosis: involves the artery or the arterial anastomosis or the juxta-anastomosis👇🏽
12/
💥 Arm Elevation Test
⚡️Raise the arm above the level of the heart, AVF will collapse if there is no outflow vein stenosis, BUT it won’t collapse if there is outflow stenosis: Video👇🏽
⚡️👆🏽test doesn’t work for AVG due to high level of pressure in AVGs
13/
⚡️Raise the arm above the level of the heart, AVF will collapse if there is no outflow vein stenosis, BUT it won’t collapse if there is outflow stenosis: Video👇🏽
⚡️👆🏽test doesn’t work for AVG due to high level of pressure in AVGs
13/
💥Palpation
⚡️Assess the ‘Thrill’ (buzz)
⚡️Thrill indicates flow in the AV access, & normally it is soft, continuous during systole & diastole
⚡️In the presence of stenosis, the thrill becomes shortened & disappears during diastole👇🏽
14/
⚡️Assess the ‘Thrill’ (buzz)
⚡️Thrill indicates flow in the AV access, & normally it is soft, continuous during systole & diastole
⚡️In the presence of stenosis, the thrill becomes shortened & disappears during diastole👇🏽
14/
💥 Palapation
⚡️Assess the pulse over the AV access
⚡️Pulse Augmentation Test: it is used to assess the ‘inflow’ portion of the AV access. See how it’s done in the figure👇🏽
15/
⚡️Assess the pulse over the AV access
⚡️Pulse Augmentation Test: it is used to assess the ‘inflow’ portion of the AV access. See how it’s done in the figure👇🏽
15/
💥 Palpation
⚡️Feel the pulse over the AV access ⚡️If it is ‘Hyperpulsatile’ then that indicates venous stenosis- figure👇🏽
16/
⚡️Feel the pulse over the AV access ⚡️If it is ‘Hyperpulsatile’ then that indicates venous stenosis- figure👇🏽
16/
💥Palpation
⚡️Sequential Occlusion Test
⚡️Is used to detect side vein branches coming off the AVF
⚡️If there is no side branch then the AVF flow (thrill) disappears when the AVF is occluded, but the thrill persists if a side branch is present: figure👇🏽
17/
⚡️Sequential Occlusion Test
⚡️Is used to detect side vein branches coming off the AVF
⚡️If there is no side branch then the AVF flow (thrill) disappears when the AVF is occluded, but the thrill persists if a side branch is present: figure👇🏽
17/
💥 Auscultation
⚡️Bruit is the auditory version of the thrill (Buzz)
⚡️It follows the same pattern as the thrill in the setting of stenosis
⚡️Bruit is continuous & low-pitched, but it becomes localized & high-pitched in the setting of stenosis
Figure👇🏽
18/
⚡️Bruit is the auditory version of the thrill (Buzz)
⚡️It follows the same pattern as the thrill in the setting of stenosis
⚡️Bruit is continuous & low-pitched, but it becomes localized & high-pitched in the setting of stenosis
Figure👇🏽
18/
💥Physical Examination of the AV
access is:
⚡️Simple
⚡️Quick
⚡️Inexpensive
⚡️Valuable in detection of stenosis &
other vascular access-related
complications
💥So learn it and do it!
☄️As Yogi Berra famously said..👇🏽
19/
access is:
⚡️Simple
⚡️Quick
⚡️Inexpensive
⚡️Valuable in detection of stenosis &
other vascular access-related
complications
💥So learn it and do it!
☄️As Yogi Berra famously said..👇🏽
19/
جاري تحميل الاقتراحات...