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

3. AV Shunt

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

6. Size Does Matter
1.6 mm – Evidence
2.0 mm - Opinion

7. Thrill Should Be Immediate

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

9. Digital Pressures

10. Steal Syndrome: Evidence
Doppler Digital Pressures (mm Hg)
Right Baseline Post Right Radial
Artery Compression
Thumb
Index
Middle
Ring
Small

11. Steal Syndrome

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

16. Beauty in Veins

17. Early Failure: Accessory Veins

18. Venous Stenosis: Not Obvious Initially

19. Retrograde Flow

20. Something Wrong?

21. Threat is Real

22. Emphasis is on Fistulas: So Why So Many Catheters?

23. AV Shunt