MEDICAL HISTORY: |
- Access creation time(3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,5757. Rodrigues AT, Colugnati FA, Bastos MG. Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist. J Bras Nefrol. 2018;40(4):326–32.)
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- Location(3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,4949. Huang SG, Rowe VL, Weaver FA, Hwang F, Woo K. Compliance with surgical follow-up does not influence fistula maturation in a county hospital population. Ann Vasc Surg. 2014;28(8):1847–52.,5353. Mufty H, Claes K, Heye S, Fourneau I. Proactive surveillance approach to guarantee a functional arteriovenous fistula at first dialysis is worth. J Vasc Access. 2015;16(3):183–8.,5656. Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol. 2017;49(9):1645–52.,5757. Rodrigues AT, Colugnati FA, Bastos MG. Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist. J Bras Nefrol. 2018;40(4):326–32.)
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- Type(3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,4949. Huang SG, Rowe VL, Weaver FA, Hwang F, Woo K. Compliance with surgical follow-up does not influence fistula maturation in a county hospital population. Ann Vasc Surg. 2014;28(8):1847–52.,5656. Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol. 2017;49(9):1645–52.)
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- Patient characteristics (age, sex, race, BMI, smoking, etiology of CKD, comorbidities, blood pressure)(1515. Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al.; por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV). Guía clínica española del acceso vascular para hemodiálisis. Nefrologia. 2017;37 Suppl 1:1–191.,3838. Ohira S, Naito H, Amano I, Azuma N, Ikeda K, Kukita K, et al.; Japanese Society for Dialysis Therapy. 2005 Japanese Society for Dialysis Therapy guidelines for vascular access construction and repair for chronic hemodialysis. Ther Apher Dial. 2006;10(5):449–62.,4444. Neves Junior MA, Melo RC, Almeida CC de, Fernandes AR, Petnys A, Iwasaki ML, et al. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise. J Vasc Bras. 2011;10(2):105–9.,4949. Huang SG, Rowe VL, Weaver FA, Hwang F, Woo K. Compliance with surgical follow-up does not influence fistula maturation in a county hospital population. Ann Vasc Surg. 2014;28(8):1847–52.,5151. López Alonso MT, Lozano Moledo V, Yuguero Ortiz A, Fontseré Baldellou N. Influencia del ejercicio físico en el desarrollo de fístulas arteriovenosas nativas. Enferm Nefrol. 2015;18(3):168–73.,5252. Cheng Q, Zhao YJ. The reasons for the failure of the primary arteriovenous fistula surgery in patients with end-stage renal disease. J Vasc Access. 2015;16 Suppl 10:S74–7.,5656. Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol. 2017;49(9):1645–52.,5757. Rodrigues AT, Colugnati FA, Bastos MG. Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist. J Bras Nefrol. 2018;40(4):326–32.)
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- History of previous intravascular catheterization(3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,3838. Ohira S, Naito H, Amano I, Azuma N, Ikeda K, Kukita K, et al.; Japanese Society for Dialysis Therapy. 2005 Japanese Society for Dialysis Therapy guidelines for vascular access construction and repair for chronic hemodialysis. Ther Apher Dial. 2006;10(5):449–62.,4444. Neves Junior MA, Melo RC, Almeida CC de, Fernandes AR, Petnys A, Iwasaki ML, et al. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise. J Vasc Bras. 2011;10(2):105–9.)
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- History of previous dialysis(4444. Neves Junior MA, Melo RC, Almeida CC de, Fernandes AR, Petnys A, Iwasaki ML, et al. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise. J Vasc Bras. 2011;10(2):105–9.,4949. Huang SG, Rowe VL, Weaver FA, Hwang F, Woo K. Compliance with surgical follow-up does not influence fistula maturation in a county hospital population. Ann Vasc Surg. 2014;28(8):1847–52.)
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- Medications in use(5656. Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol. 2017;49(9):1645–52.)
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- Biochemical parameters(5656. Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol. 2017;49(9):1645–52.)
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INSPECTION: |
- Visible vein extension (> 10 cm)(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,2828. Ferring M, Henderson J, Wilmink T. Accuracy of early postoperative clinical and ultrasound examination of arteriovenous fistulae to predict dialysis use. J Vasc Access. 2014;15(4):291–7.,2929. Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH, et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology. 2002;225(1):59–64.,3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,3636. Kian K, Vassalotti JA. The new arteriovenous fistula: the need for earlier evaluation and intervention. Semin Dial. 2005;18(1):3–7.,4747. Salimi F, Majd Nassiri G, Moradi M, Keshavarzian A, Farajzadegan Z, Saleki M, et al. Assessment of effects of upper extremity exercise with arm tourniquet on maturity of arteriovenous fistula in hemodialysis patients. J Vasc Access. 2013;14(3):239–44.,5454. Rosenberg JE, Yevzlin AS, Chan MR, Valliant AM, Astor BC. Prediction of Arteriovenous Fistula Dysfunction: can it be Taught? Semin Dial. 2015;28(5):544–7.–5656. Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol. 2017;49(9):1645–52.)
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-Very well developed, straight, without areas of irregularity or aneurysms(1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,2828. Ferring M, Henderson J, Wilmink T. Accuracy of early postoperative clinical and ultrasound examination of arteriovenous fistulae to predict dialysis use. J Vasc Access. 2014;15(4):291–7.,2929. Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH, et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology. 2002;225(1):59–64.)
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- Signs of central venous stenosis: Edema in the arm, chest, neck or face(1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,2424. Coentrão L, Faria B, Pestana M. Physical examination of dysfunctional arteriovenous fistulae by non-interventionalists: a skill worth teaching. Nephrol Dial Transplant. 2012;27(5):1993–6.,2525. McLafferty RB, Pryor RW 3rd, Johnson CM, Ramsey DE, Hodgson KJ. Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access. J Vasc Surg. 2007;45(5):981–5.,3030. Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist? Semin Dial. 2008;21(6):557–60.,3737. Asif A, Roy-Chaudhury P, Beathard GA. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol. 2006;1(2):332–9.,3939. Jiménez Almonacid P, Enrique Gruss E, Lorenzo S, Lasala M, Hernández T, Portolés J, et al. Definición de procesos e indicadores para la gestión de accesos vasculares para hemodiálisis. Cir Esp Ed Impr. 2007;81(5):257–63.,5353. Mufty H, Claes K, Heye S, Fourneau I. Proactive surveillance approach to guarantee a functional arteriovenous fistula at first dialysis is worth. J Vasc Access. 2015;16(3):183–8.)
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- Signs of infection in the operative wound (flushing, edema, secretion, erythema, cellulitis, ulcerations, cracks)(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,2727. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V. Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol. 2014;46(2):403–9.,3131. George D. Beaumont Hospital. Guidelines on the management of arterio venous fistula and grafts [Internet]. Dublin: Beaumont Hospital; 2012. [cited 2020 Jun 16]. Available from: http://www.beaumont.ie/media/AVFguidelinefinalcopy1.pdf http://www.beaumont.ie/media/AVFguidelin...
,3232. Parosotto ME, Pancirova J, editores. Canulação e cuidado do acesso vascular. Manual de boas práticas de enfermagem para a fístula arteriovenosa. 2a ed. Madrid: Tomás Hermannos; 2015.,4141. McCann M, Einarsdóttir H, Van Waeleghem JP, Murphy F, Sedgewick J. Vascular access management 1: an overview. J Ren Care. 2008;34(2):77–84.,4747. Salimi F, Majd Nassiri G, Moradi M, Keshavarzian A, Farajzadegan Z, Saleki M, et al. Assessment of effects of upper extremity exercise with arm tourniquet on maturity of arteriovenous fistula in hemodialysis patients. J Vasc Access. 2013;14(3):239–44.–4949. Huang SG, Rowe VL, Weaver FA, Hwang F, Woo K. Compliance with surgical follow-up does not influence fistula maturation in a county hospital population. Ann Vasc Surg. 2014;28(8):1847–52.)
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-Hematoma in the surgical wound(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,4444. Neves Junior MA, Melo RC, Almeida CC de, Fernandes AR, Petnys A, Iwasaki ML, et al. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise. J Vasc Bras. 2011;10(2):105–9.,4747. Salimi F, Majd Nassiri G, Moradi M, Keshavarzian A, Farajzadegan Z, Saleki M, et al. Assessment of effects of upper extremity exercise with arm tourniquet on maturity of arteriovenous fistula in hemodialysis patients. J Vasc Access. 2013;14(3):239–44.,4949. Huang SG, Rowe VL, Weaver FA, Hwang F, Woo K. Compliance with surgical follow-up does not influence fistula maturation in a county hospital population. Ann Vasc Surg. 2014;28(8):1847–52.)
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- Seroma(5454. Rosenberg JE, Yevzlin AS, Chan MR, Valliant AM, Astor BC. Prediction of Arteriovenous Fistula Dysfunction: can it be Taught? Semin Dial. 2015;28(5):544–7.)
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- Signs of theft syndrome: Pale, cyanotic limb, ulcerations, flaking, discoloration of the nail bed(1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,4646. Rose DA, Sonaike E, Hughes K. Hemodialysis access. Surg Clin North Am. 2013;93(4):997–1012.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.)
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- Signs of venous hypertension syndrome: Edema of the arm, hyperpigmentation of the skin, collateral veins in the chest, ulcerations in the extremity(2727. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V. Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol. 2014;46(2):403–9.,3232. Parosotto ME, Pancirova J, editores. Canulação e cuidado do acesso vascular. Manual de boas práticas de enfermagem para a fístula arteriovenosa. 2a ed. Madrid: Tomás Hermannos; 2015.,3636. Kian K, Vassalotti JA. The new arteriovenous fistula: the need for earlier evaluation and intervention. Semin Dial. 2005;18(1):3–7.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.)
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- High output heart failure: increased expansion of the venous segment(4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.)
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- Checking of accessory veins(1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,2525. McLafferty RB, Pryor RW 3rd, Johnson CM, Ramsey DE, Hodgson KJ. Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access. J Vasc Surg. 2007;45(5):981–5.–2727. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V. Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol. 2014;46(2):403–9.,3030. Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist? Semin Dial. 2008;21(6):557–60.,3232. Parosotto ME, Pancirova J, editores. Canulação e cuidado do acesso vascular. Manual de boas práticas de enfermagem para a fístula arteriovenosa. 2a ed. Madrid: Tomás Hermannos; 2015.,3434. Mattiazzi AD. Evaluación clínica del acceso vascular. Rev Nefrol Diál Traspl. 1999;(48):17–25.,3939. Jiménez Almonacid P, Enrique Gruss E, Lorenzo S, Lasala M, Hernández T, Portolés J, et al. Definición de procesos e indicadores para la gestión de accesos vasculares para hemodiálisis. Cir Esp Ed Impr. 2007;81(5):257–63.,4242. Nassar GM. Endovascular management of the “failing to mature” arteriovenous fistula. Tech Vasc Interv Radiol. 2008;11(3):175–80.–4444. Neves Junior MA, Melo RC, Almeida CC de, Fernandes AR, Petnys A, Iwasaki ML, et al. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise. J Vasc Bras. 2011;10(2):105–9.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.,5050. Malovrh M. Postoperative assessment of vascular access. J Vasc Access. 2014;15 Suppl 7:S10–4.)
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-Arm elevation test: Normal with the collapsing vein and abnormal with the non-collapsing vein (sign of stenosis)(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,1515. Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al.; por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV). Guía clínica española del acceso vascular para hemodiálisis. Nefrologia. 2017;37 Suppl 1:1–191.,2424. Coentrão L, Faria B, Pestana M. Physical examination of dysfunctional arteriovenous fistulae by non-interventionalists: a skill worth teaching. Nephrol Dial Transplant. 2012;27(5):1993–6.,2626. Sidawy AN, Spergel LM, Besarab A, Allon M, Jennings WC, Padberg FT Jr, et al.; Society for Vascular Surgery. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg. 2008;48(5 Suppl):2S–25S.,2727. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V. Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol. 2014;46(2):403–9.,3030. Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist? Semin Dial. 2008;21(6):557–60.,4343. Malovrh M. Non-matured arteriovenous fistulae for haemodialysis: diagnosis, endovascular and surgical treatment. Bosn J Basic Med Sci. 2010;10 Suppl 1:S13–7.,4646. Rose DA, Sonaike E, Hughes K. Hemodialysis access. Surg Clin North Am. 2013;93(4):997–1012.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.,5353. Mufty H, Claes K, Heye S, Fourneau I. Proactive surveillance approach to guarantee a functional arteriovenous fistula at first dialysis is worth. J Vasc Access. 2015;16(3):183–8.)
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- Signs of venous stenosis (narrowing of the vein, sudden decrease/absence, aneurysms, edema of the extremity)(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,1515. Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al.; por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV). Guía clínica española del acceso vascular para hemodiálisis. Nefrologia. 2017;37 Suppl 1:1–191.,2727. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V. Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol. 2014;46(2):403–9.,3232. Parosotto ME, Pancirova J, editores. Canulação e cuidado do acesso vascular. Manual de boas práticas de enfermagem para a fístula arteriovenosa. 2a ed. Madrid: Tomás Hermannos; 2015.,3333. Thomas N. Renal rursing. 4th ed. England: Wiley-Blackwell; 2013.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.)
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PALPATION: |
- Pulse: Normal - smooth, easily compressible and abnormal (sign of stenosis or inadequate maturation): hyperpulsatile, in a water hammer, or absent(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,1515. Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al.; por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV). Guía clínica española del acceso vascular para hemodiálisis. Nefrologia. 2017;37 Suppl 1:1–191.,2323. Beathard GA. Physical examination of the dialysis vascular access. Semin Dial. 1998;11(4):231–6.–2828. Ferring M, Henderson J, Wilmink T. Accuracy of early postoperative clinical and ultrasound examination of arteriovenous fistulae to predict dialysis use. J Vasc Access. 2014;15(4):291–7.,3030. Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist? Semin Dial. 2008;21(6):557–60.,3434. Mattiazzi AD. Evaluación clínica del acceso vascular. Rev Nefrol Diál Traspl. 1999;(48):17–25.,3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,3737. Asif A, Roy-Chaudhury P, Beathard GA. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol. 2006;1(2):332–9.,4040. Levine MI. A challenge for nephrologists-increasing fistula maturation rates, reducing fistula maturation time, and decreasing dialysis catheter prevalence in the United States. Semin Dial. 2008;21(3):280-4.,4242. Nassar GM. Endovascular management of the “failing to mature” arteriovenous fistula. Tech Vasc Interv Radiol. 2008;11(3):175–80.–4444. Neves Junior MA, Melo RC, Almeida CC de, Fernandes AR, Petnys A, Iwasaki ML, et al. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise. J Vasc Bras. 2011;10(2):105–9.,4646. Rose DA, Sonaike E, Hughes K. Hemodialysis access. Surg Clin North Am. 2013;93(4):997–1012.–4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.,5050. Malovrh M. Postoperative assessment of vascular access. J Vasc Access. 2014;15 Suppl 7:S10–4.,5151. López Alonso MT, Lozano Moledo V, Yuguero Ortiz A, Fontseré Baldellou N. Influencia del ejercicio físico en el desarrollo de fístulas arteriovenosas nativas. Enferm Nefrol. 2015;18(3):168–73.,5353. Mufty H, Claes K, Heye S, Fourneau I. Proactive surveillance approach to guarantee a functional arteriovenous fistula at first dialysis is worth. J Vasc Access. 2015;16(3):183–8.,5454. Rosenberg JE, Yevzlin AS, Chan MR, Valliant AM, Astor BC. Prediction of Arteriovenous Fistula Dysfunction: can it be Taught? Semin Dial. 2015;28(5):544–7.,5656. Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol. 2017;49(9):1645–52.,5757. Rodrigues AT, Colugnati FA, Bastos MG. Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist. J Bras Nefrol. 2018;40(4):326–32.)
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- Pulse increase test: Normal - with pulse increased above the occlusion point and abnormal: Weak or absent pulse above the occluded point(2424. Coentrão L, Faria B, Pestana M. Physical examination of dysfunctional arteriovenous fistulae by non-interventionalists: a skill worth teaching. Nephrol Dial Transplant. 2012;27(5):1993–6.,2727. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V. Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol. 2014;46(2):403–9.,3030. Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist? Semin Dial. 2008;21(6):557–60.,3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,3737. Asif A, Roy-Chaudhury P, Beathard GA. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol. 2006;1(2):332–9.,4242. Nassar GM. Endovascular management of the “failing to mature” arteriovenous fistula. Tech Vasc Interv Radiol. 2008;11(3):175–80.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.,5050. Malovrh M. Postoperative assessment of vascular access. J Vasc Access. 2014;15 Suppl 7:S10–4.,5151. López Alonso MT, Lozano Moledo V, Yuguero Ortiz A, Fontseré Baldellou N. Influencia del ejercicio físico en el desarrollo de fístulas arteriovenosas nativas. Enferm Nefrol. 2015;18(3):168–73.,5353. Mufty H, Claes K, Heye S, Fourneau I. Proactive surveillance approach to guarantee a functional arteriovenous fistula at first dialysis is worth. J Vasc Access. 2015;16(3):183–8.)
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- Signs of infection: increased temperature, abscess, hardening or fluctuations in the area(1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.)
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- Palpation of depth (should not be too deep: less than 6 mm) and vein diameter: at least 6 mm(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,2525. McLafferty RB, Pryor RW 3rd, Johnson CM, Ramsey DE, Hodgson KJ. Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access. J Vasc Surg. 2007;45(5):981–5.,2626. Sidawy AN, Spergel LM, Besarab A, Allon M, Jennings WC, Padberg FT Jr, et al.; Society for Vascular Surgery. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg. 2008;48(5 Suppl):2S–25S.,2828. Ferring M, Henderson J, Wilmink T. Accuracy of early postoperative clinical and ultrasound examination of arteriovenous fistulae to predict dialysis use. J Vasc Access. 2014;15(4):291–7.,2929. Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH, et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology. 2002;225(1):59–64.,3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,4646. Rose DA, Sonaike E, Hughes K. Hemodialysis access. Surg Clin North Am. 2013;93(4):997–1012.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.,5656. Martinez L, Esteve V, Yeste M, Artigas V, Llagostera S. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients. Int Urol Nephrol. 2017;49(9):1645–52.,5757. Rodrigues AT, Colugnati FA, Bastos MG. Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist. J Bras Nefrol. 2018;40(4):326–32.)
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- Thrill: Normal - present, uniform throughout the entire venous path; and abnormal (sign of stenosis), if only systolic or absent(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,1515. Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al.; por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV). Guía clínica española del acceso vascular para hemodiálisis. Nefrologia. 2017;37 Suppl 1:1–191.,2323. Beathard GA. Physical examination of the dialysis vascular access. Semin Dial. 1998;11(4):231–6.–3131. George D. Beaumont Hospital. Guidelines on the management of arterio venous fistula and grafts [Internet]. Dublin: Beaumont Hospital; 2012. [cited 2020 Jun 16]. Available from: http://www.beaumont.ie/media/AVFguidelinefinalcopy1.pdf http://www.beaumont.ie/media/AVFguidelin...
,3333. Thomas N. Renal rursing. 4th ed. England: Wiley-Blackwell; 2013.–4141. McCann M, Einarsdóttir H, Van Waeleghem JP, Murphy F, Sedgewick J. Vascular access management 1: an overview. J Ren Care. 2008;34(2):77–84.,4343. Malovrh M. Non-matured arteriovenous fistulae for haemodialysis: diagnosis, endovascular and surgical treatment. Bosn J Basic Med Sci. 2010;10 Suppl 1:S13–7.,4444. Neves Junior MA, Melo RC, Almeida CC de, Fernandes AR, Petnys A, Iwasaki ML, et al. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise. J Vasc Bras. 2011;10(2):105–9.,4646. Rose DA, Sonaike E, Hughes K. Hemodialysis access. Surg Clin North Am. 2013;93(4):997–1012.–5757. Rodrigues AT, Colugnati FA, Bastos MG. Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist. J Bras Nefrol. 2018;40(4):326–32.)
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- Acknowledge of accessory veins: perform manual occlusion of the venous segment, the presence of thrill below the occluded point is indicative of the presence of accessory veins(1515. Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al.; por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV). Guía clínica española del acceso vascular para hemodiálisis. Nefrologia. 2017;37 Suppl 1:1–191.,2323. Beathard GA. Physical examination of the dialysis vascular access. Semin Dial. 1998;11(4):231–6.,3434. Mattiazzi AD. Evaluación clínica del acceso vascular. Rev Nefrol Diál Traspl. 1999;(48):17–25.–3737. Asif A, Roy-Chaudhury P, Beathard GA. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol. 2006;1(2):332–9.,4040. Levine MI. A challenge for nephrologists-increasing fistula maturation rates, reducing fistula maturation time, and decreasing dialysis catheter prevalence in the United States. Semin Dial. 2008;21(3):280-4.,4242. Nassar GM. Endovascular management of the “failing to mature” arteriovenous fistula. Tech Vasc Interv Radiol. 2008;11(3):175–80.–4444. Neves Junior MA, Melo RC, Almeida CC de, Fernandes AR, Petnys A, Iwasaki ML, et al. Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise. J Vasc Bras. 2011;10(2):105–9.,4646. Rose DA, Sonaike E, Hughes K. Hemodialysis access. Surg Clin North Am. 2013;93(4):997–1012.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.,5050. Malovrh M. Postoperative assessment of vascular access. J Vasc Access. 2014;15 Suppl 7:S10–4.)
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- Theft syndrome sign: cold skin, decreased radial pulse, pain on mobilizing the hand(4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.), positive Allen test(3131. George D. Beaumont Hospital. Guidelines on the management of arterio venous fistula and grafts [Internet]. Dublin: Beaumont Hospital; 2012. [cited 2020 Jun 16]. Available from: http://www.beaumont.ie/media/AVFguidelinefinalcopy1.pdf http://www.beaumont.ie/media/AVFguidelin...
)
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- Signs of venous hypertension syndrome: edema, pain in the hand and fingers(4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.)
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- High output heart failure: increased intensity of thrill and murmur, increased arterial pulse, AVF occlusion decreases heart rate (Nicoladoni Branham sign)(4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.)
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- Just-anastomotic stenosis: presence of a prominent pulse in the anastomosis (water hammer), decreased thrill, insufficient development of AVF after the stenosis site, presence of a weak pulse after compression of the outgoing vein(1515. Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G, Martí-Monrós A, et al.; por el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV). Guía clínica española del acceso vascular para hemodiálisis. Nefrologia. 2017;37 Suppl 1:1–191.,2323. Beathard GA. Physical examination of the dialysis vascular access. Semin Dial. 1998;11(4):231–6.,3030. Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist? Semin Dial. 2008;21(6):557–60.,3232. Parosotto ME, Pancirova J, editores. Canulação e cuidado do acesso vascular. Manual de boas práticas de enfermagem para a fístula arteriovenosa. 2a ed. Madrid: Tomás Hermannos; 2015.,3434. Mattiazzi AD. Evaluación clínica del acceso vascular. Rev Nefrol Diál Traspl. 1999;(48):17–25.,3535. Beathard GA. An algorithm for the physical examination of early fistula failure. Semin Dial. 2005;18(4):331–5.,3737. Asif A, Roy-Chaudhury P, Beathard GA. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol. 2006;1(2):332–9.,4040. Levine MI. A challenge for nephrologists-increasing fistula maturation rates, reducing fistula maturation time, and decreasing dialysis catheter prevalence in the United States. Semin Dial. 2008;21(3):280-4.,4343. Malovrh M. Non-matured arteriovenous fistulae for haemodialysis: diagnosis, endovascular and surgical treatment. Bosn J Basic Med Sci. 2010;10 Suppl 1:S13–7.,5050. Malovrh M. Postoperative assessment of vascular access. J Vasc Access. 2014;15 Suppl 7:S10–4.)
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AUSCULTATION: |
- Breath characteristics: Normal - continuous and low frequency; and abnormal (sign of stenosis or inadequate maturation) discontinuous, high frequency, little or inaudible(1010. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; Esvs Guidelines Reviewers. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818.,1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.,2525. McLafferty RB, Pryor RW 3rd, Johnson CM, Ramsey DE, Hodgson KJ. Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access. J Vasc Surg. 2007;45(5):981–5.–2828. Ferring M, Henderson J, Wilmink T. Accuracy of early postoperative clinical and ultrasound examination of arteriovenous fistulae to predict dialysis use. J Vasc Access. 2014;15(4):291–7.,3030. Leon C, Asif A. Physical examination of arteriovenous fistulae by a renal fellow: does it compare favorably to an experienced interventionalist? Semin Dial. 2008;21(6):557–60.–3333. Thomas N. Renal rursing. 4th ed. England: Wiley-Blackwell; 2013.,3838. Ohira S, Naito H, Amano I, Azuma N, Ikeda K, Kukita K, et al.; Japanese Society for Dialysis Therapy. 2005 Japanese Society for Dialysis Therapy guidelines for vascular access construction and repair for chronic hemodialysis. Ther Apher Dial. 2006;10(5):449–62.,3939. Jiménez Almonacid P, Enrique Gruss E, Lorenzo S, Lasala M, Hernández T, Portolés J, et al. Definición de procesos e indicadores para la gestión de accesos vasculares para hemodiálisis. Cir Esp Ed Impr. 2007;81(5):257–63.,4141. McCann M, Einarsdóttir H, Van Waeleghem JP, Murphy F, Sedgewick J. Vascular access management 1: an overview. J Ren Care. 2008;34(2):77–84.,4242. Nassar GM. Endovascular management of the “failing to mature” arteriovenous fistula. Tech Vasc Interv Radiol. 2008;11(3):175–80.,4545. Ahmed GM, Mansour MO, Elfatih M, Khalid KE, Ahmed MI. Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: single-center experience. Saudi J Kidney Dis Transpl. 2012;23(1):152–7.,4646. Rose DA, Sonaike E, Hughes K. Hemodialysis access. Surg Clin North Am. 2013;93(4):997–1012.,4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.,5050. Malovrh M. Postoperative assessment of vascular access. J Vasc Access. 2014;15 Suppl 7:S10–4.–5252. Cheng Q, Zhao YJ. The reasons for the failure of the primary arteriovenous fistula surgery in patients with end-stage renal disease. J Vasc Access. 2015;16 Suppl 10:S74–7.,5757. Rodrigues AT, Colugnati FA, Bastos MG. Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist. J Bras Nefrol. 2018;40(4):326–32.)
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- Theft syndrome sign: AVF can have a very strong murmur(1414. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176–247.)
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- High output heart failure: intense and continuous murmur along the vein to the beginning of the arm and precordial region(4848. Sousa CN, Apóstolo JL, Figueiredo MH, Martins MM, Dias VF. Physical examination: how to examine the arm with arteriovenous fistula. Hemodial Int. 2013;17(2):300–6.)
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