Hemodialysis Access Fistulas & Grafts

c. insulin

All of the following waste products are removed from the blood via hemodialysis except:

a. urea

b. free water

c. insulin

d. creatinine

a. 300,000-400,000

___________ patients in the USA are dialysis dependent.

a. 300,000-400,000

b. 10,000-20,000

c. 500,000-600,000

d. One million

Hemodialysis

___________ is a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood.

to help impaired renal function

What is the main purpose of dialysis?

peri-graft abscess

A _________ is a pocket of pus that's caused by a bacterial infection.

central venous catheter

A _________ is a thin, flexible tube that is inserted into a vein, usually below the right collarbone, and guided (threaded) into a large vein above the right side of the heart.

AV fistula

A ___________ is a surgically created communication between the native artery and the vein in an extremity.

Brescia-Cimino [arteriovenous] fistula

The __________ is the preferred method of providing vascular access for hemodialysis in patients with end-stage renal disease

Radial A to Cephalic V

What is the most common connection for the Brescia-Cimino fistula?

D. in the non-dominant arm

Which arm is a native access fistula typically placed in?

A. always the left

B. always the right

C. in the dominant arm

D. in the non-dominant arm

B. easy installation

All of the following are benefits of arterial-venous fistulas (AVF) EXCEPT:

A. autogenous

B. easy installation

C. long term patency

D. low complication rate

mature

If not, adequate flow volume may not occur due to inconsistent vein diameter.

Native access fistulas must be allowed to ________ before use.

increased intraluminal pressure

In a patient with a native access fistula, vein segments can become lumpy and sausage shaped over time due to ___________.

B. used between 2 veins

Which of the following does NOT apply to synthetic tube grafts:

A. used for dialysis puncture

B. used between 2 veins

C. used when veins are inadequate

D. useful when fistulas have failed

arterial

Access grafts may be tapered at the ________ end to reduce flow volume.

Teflon (PTFE)

Access grafts are usually made of ________.

Access grafts

___________ are commercially known as Gore-Tex.

ultrasound cannot penetrate them

What is the main disadvantage of polyurethane access grafts?

forearm

Grafts and fistulas are usually created initially in the ________.

Grafts, fistulas

_________ tend to have shorter duration and lower patency than _________.

fistulas, grafts

In the US, there is a growing number of ________ compared to ________.

native fistulas

In Europe and Asia, about 80% of hemodialysis patients have _____________.

D. > 2mm

Preoperative arterial lumen diameter must be _______.

A. < 3mm

B. > 3mm

C. < 2mm

D. > 2mm

palmar arch

Patients must have adequate arterial inflow and a patent _________.

Allen test

The __________ is used to assess the patency of the palmar arch.

< 20 mmHg

Prior to fistula placement, a _______ mmHg pressure gradient must exist between bilateral brachial pressures.

≥ 50 cm/sec

Preoperatively, the patient must have a patent palmar arch, no artery stenosis or occlusion, and a distal radial velocity PSV ________ cm/sec.

≥ 4mm

Preoperative vein lumen diameter must be ________mm for a dialysis graft.

1 cm

Prior to the placement of a dialysis graft or AVF placement, the assessed vein must be within _____ cm of the skin surface.

A.

elevated RIGHT heart pressure can occur

Complications that can occur in patients with grafts/fistulas include all EXCEPT:

A. elevated left heart pressure

B. arterial steal

C. aneurysms and pseudoaneurysms

D. thrombosis/occlusion

false

True or False: Blood pressure can be taken over a synthetic graft.

pseudoaneurysms

In patients with grafts/fistulas, lumps may indicate ________.

upper brachial to distal radial artery

During a general ultrasound survey of a graft/fistula, scan from ________ to _________ artery.

occlusion

High resistance arterial flow proximal to the fistula is indicative of fistula _________.

graft, fistula

Vein stenosis is more likely to occur with a _______ than a _______.

high, low

In a normal graft/fistula, there should be _______ flow and _______ resistance.

> 2:1

When assessing a graft/fistula, a doctor should be notified if there's any velocity ratio that's ______.

B. Incomplete palmar arch

In a patient with a hemodialysis access forearm loop graft, digital ischemia can result from which of the following conditions?

A. Thrombosed hemodialysis access graft

B. Incomplete palmar arch

C. Pseudoaneurysm

D. Venous outflow obstruction

D. Basilic

Which of the following veins does not have an accompanying artery?

A. Subclavian

B. Axillary

C. Brachial

D. Basilic

C. 2.5 mm

What is considered to be the lowest vein diameter suitable for an arterial to venous hemodialysis fistula?

A. 1.5 mm

B 2.0 mm

C. 2.5 mm

D. 2.0 mm

D. Vectra

Which of the following grafts is impenetrable by ultrasound?

A. Gore-tex

B. Bovine

C. Atrium

D. Vectra

D. Patent palmar arch

Revere flow detected in the distal radial artery of an ipsilateral radial artery to basilic vein graft indicates which of the following conditions?

A. Impending graft failure

B. Occluded ulnar artery

C. Incompetent palmar arch

D. Patent palmar arch