ANAMNESE: |
-Tempo de criação do acesso(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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-Localização(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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-Tipo(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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-Características do paciente (idade, sexo, raça, IMC, tabagismo, etiologia da DRC, comorbidades, pressão arterial)(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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-História de cateterização intravascular prévia(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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-História de diálise prévia(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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-Medicações em uso(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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-Parâmetros bioquímicos(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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INSPEÇÃO: |
-Extensão de veia visível (>10cm)(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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-Veia bem desenvolvida, reta, sem áreas de irregularidade ou aneurismas(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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-Sinais de estenose venosa central: Edema em braço, tórax, pescoço ou 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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-Sinais de infecção na ferida operatória (rubor, edema, secreção, eritema, celulite, ulcerações, rachaduras)(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 na ferida operatória(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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- Sinais de síndrome do roubo: Membro pálido, cianótico, ulcerações, descamação, descoloração do leito ungueal(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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-Sinais de síndrome de hipertensão venosa: Edema de braço, hiperpigmentação da pele, veias colaterais no peito, ulcerações na extremidade(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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-Insuficiência cardíaca de alto débito: expansão aumentada do segmento venoso(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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-Checagem de veias acessórias(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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-Teste de elevação do braço: Normal com a veia colapsando e anormal com veia não colapsando (sinal de estenose)(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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-Sinais de estenose venosa (estreitamento da veia, diminuição/ausência súbita, aneurismas, edema de extremidade)(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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PALPAÇÃO: |
-Pulso: Normal - suave, facilmente compressível e anormal (sinal de estenose ou maturação inadequada): hiperpulsátil, em martelo d'água, ou ausente(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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-Teste de aumento do pulso: Normal - com pulso aumentado acima do ponto de oclusão e anormal: Pulso fraco ou ausente acima do ponto ocluído(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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-Sinais de infecção: aumento da temperatura, abcesso, endurecimento ou flutuações na área(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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-Palpação da profundidade (não deve ser muito profunda: menos de 6 mm) e diâmetro da veia: pelo menos 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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-Frêmito: Normal – presente, uniforme ao longo de todo trajeto venoso; e anormal (sinal de estenose), se apenas sistólico ou ausente(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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-Checagem de veias acessórias: realizar oclusão manual do segmento venoso, a presença de frêmito abaixo do ponto ocluído é indicativo de presença de veias acessórias(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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-Sinal de Síndrome do Roubo: pele fria, pulso radial diminuído, dor o mobilizar a mão(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.), teste de Allen positivo(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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-Sinais de síndrome de hipertensão venosa: edema, dor na mão e dedos(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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-Insuficiência cardíaca de alto débito: aumento na intensidade do frêmito e sopro, aumento do pulso arterial, oclusão da FAV diminui frequência cardíaca (sinal de Nicoladoni Branham)(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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-Estenose justa-anastomótica: presença de pulso proeminente na anastomose (martelo d'água), frêmito diminuído, desenvolvimento insuficiente da FAV após o local da estenose, presença de pulso fraco após compressão da veia de saída(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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AUSCULTA: |
-Características do sopro: Normal – contínuo e de baixa frequência; e anormal (sinal de estenose ou maturação inadequada) descontínuo, alta frequência, pouco ou inaudível(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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-Sinal de síndrome do roubo: FAV pode ter um sopro muito forte(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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-Insuficiência cardíaca de alto débito: sopro intenso e contínuo ao longo da veia até o início do braço e região precordial(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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