The Value of Physical Exam In Access Maintenance and Acquisition

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Presentation transcript:

The Value of Physical Exam In Access Maintenance and Acquisition Carol M. Headley RN DNSc CNN Network 8 November 2006 Nashville, Tennessee

AV Shunt

Physical Exam Chest and Arms Uncovered Lying Supine Position Dominant Arm and Hand Determined Previous Surgeries Peripheral Vascular Disease Diabetic IV Drug Abuse

Size Does Matter 1.6 mm – Evidence 2.0 mm - Opinion

Thrill Should Be Immediate

Arterial Portion of Evaluation Pulse Examination – Roll Artery Segmental Blood Pressures Digital Pressures Allen Test Ultrasound

Digital Pressures

Steal Syndrome: Evidence Doppler Digital Pressures (mm Hg) Right Baseline Post Right Radial Artery Compression Thumb 45 94 Index 46 140 Middle 56 104 Ring 90 126 Small 88 118

Steal Syndrome

Venous Evaluation Most Problems are Venous Related Cephalic Vein is Optimal Luminal Diameter 2.5 mm Absence of Obstruction Straight Superficial Continuity – Tap Test

Beauty in Veins

Early Failure: Accessory Veins

Venous Stenosis: Not Obvious Initially

Retrograde Flow

Something Wrong?

Threat is Real

Emphasis is on Fistulas: So Why So Many Catheters?

AV Shunt