Thrill
9 Normally only present at the
anastamosis.
9 A thrill can be felt at a major stenosis.
Palpation
Vein Diameter
Bruit
• Turbulence
for
Cannulation
Skin Preparation
with
dialysis
Hemolysis - Arterial Pressure
• The blood is removed from the patient
by a negative pulling pressure.
• Caused by
sticking needles
in the same
general area.
• Cause stenosis
formation
because of
turbulence
Photo courtesy of P. Cade
“One-site-itis”
• “One-site-itis”
occurs when you Vascular Access
• Causes aneurysm
and stenosis
formation.
Thrombosis in AV Fistula
• Early cause:
*surgical
*technical issues
• Late causes:
* poor blood flow
*hypotension
*hypercoagulability
*patient compressing while sleeping
Clamps - Holding Sites
Cannulation
Techniques
Buttonhole –
The old
becomes
new
again!
Facts About Buttonhole
New
AV Fistula
Cannulating a New AVF
of
Grafts
to AV Fistulae
“Sleeves Up” Protocol
• Converting an AV graft to an AV fistula before
AV graft fails.
• Place a light tourniquet just below the shoulder.
• If vessel appears to be well developed, order a
fistulogram - all the way to the heart. (MD order)
• If the fistulogram is normal, cannulate the
outflow vein with the venous needle for 2
consecutive treatments. (MD order)
• If no problems with these cannulations, patient
should be scheduled for a surgical conversion.
Dr. Larry Spergel
In Closing…