评估新AVF的成熟.ppt

* * * * * * * * * Palpation (cont’d) Feel for Size, Depth, Diameter, and Straightness of AVF Feel the entire AVF from arterial anastomosis all the way up the vein Evaluate for possible cannulation sites = superficial, straight vein section with adequate and consistent vein diameter * Auscultation Listen for the Nature of the Bruit Photo courtesy of J. Holland * Auscultation (cont’d) Listen for Bruit Listen to entire access every treatment Note changes in sound characteristics (bruit): A well-functioning fistula should have a continuous, machinery-like bruit on auscultation An obstructed (stenotic) fistula may have a discontinuous and pulse-like bruit rather than a continuous one—and also may be louder and high-pitched or “whistling” Louder at stenosis than at anastomosis * Requirements for Cannulation Physician order Experienced, qualified staff person Tourniquet * Post-Op Follow-up Communicate assessment findings with access team, including surgeon Check maturity progress every session Assure evaluation by surgeon 4 weeks post-op Intervene if there is no progress at 4 weeks or AVF is not mature and ready for cannulation at 6–8 weeks * * * * * * * * * * * * * * * * * * * * * * * * * * * Assessment of the New AVF for Maturity * Fistula Maturation Definition: Process by which a fistula becomes suitable for cannulation (ie, develops adequate flow, wall thickness, and diameter) Rule of 6’s: In general, a mature fistula should: Be a minimum of 6 mm in diameter with discernible margins when a tourniquet is in place Be less than 6 mm deep Have a blood flow greater than 600 mL/min Be evaluated for nonmaturation 4–6 weeks after surgical creation if it does not meet the above criteria National Kidney Foundation. Am J Kidney Dis. 2006;48(suppl 1):S1-S322. * Clinical Clarification The fistula should be examined regularly following surgery. At 4 weeks post surgery, the fistula should be evaluated specifically for nonma