Ch 30 - Hemodialysis Access Grafts + Fistulas

A _____ is an INDIRECT connection bw a art/vein

graft

A _____ is when a NATIVE art/vein are directly connected

Fistula

A Fistula is more _____ then a a graft, has a better ____ (long/short) term patency rate but has a ____ (high/low) maturation rate + higher early ____ rate

durable, long, low, thrombosis

_____ = the process of purifying the blood of a person whose kidneys are not working normally 

hemodialysis 

The goal of an access is to provide ____ (long/short) term hemodialysis access with a ____ (high/low) frequency re-intervention rate + ___ (high/low) complication rate

long, low, low

T/F: You can take a BP on someone with a graft/fistula

False

Another GOAL of a access is to have a far ____ fistula in the patients ____ arm

distal, non-dominant

Upper extrem. are preferred bc the have a LOWER ____ rate + are easier to ______

infection, access

List 3 contraindications of a access 

• ____ ____ catheters 

• _____ 

• ______

central venous, pacemakers, defibrillators 

The ___ sys is eval first and all diameters should ____ mm

>2 mm

The patients _____ arm should be eval first then the ____ arm

non-dominant, dominant

The ____, _____, _____ art diameters should measure _____mm

radial, ulnar, brachial, > 2mm

Vein ____ is performed to determine suitability of veins for placement of fistula 

mapping 

Vein diameter should be _____ mm 

> 2.5 mm

The _____ ARTERY → _____ VEIN is a common location where a fistula is placed in the ____ fossa

basilic, cephalic, antecubital

Basilic Vein → Brachial, Radial, or Ulnar artery fistula the Basilic vein must be _____ 

transposed 

Fistula Maturity takes __-__ wks and is defined as ___, easily ____,____, Flow Rate _____ mL/min, and PSV ____-____ cm/s 

8-12, dilated, palpable, thrill, >350, 150-300

_____ or ____ veins are associated with LOW  maturation rates 

small, suboptimal

List 4 indications for a “follow-up” US of a Fistula 

• _____ formation 

• _____ stenosis 

• ______ flow  

• Decreased _____

PSA, Arterial, pulsatile, thrombosis 

Before you begin the exam you should asses the presence/quality of _____

thrill 

MOST COMMON access type in the FOREARM is the _____ - ____ fistula at the _____ (location on arm)

Brescia-Cimino, wrist

MOST COMMON access type in the UPPER ARM is the______ _____ → _____ _____ at the antecubital fossa 

brachial artery, cephalic vein

MOST COMMON access type in the LOWER EXTREM is the _____ → _____/_____

CFA, GSV/CFV

This is an example of a ______ fistula

brachiocephalic

This is an example of a ______ ______ fistula

Basilic transposition

The main difference bw a Graft and a Fistula.

Graft = ___ connection points using ____ material 

Fistula = ___ connection point using _____ material 

2, synthetic, 1, native 

It’s important to doc a venous/arterial _____, where ____ (arterial/venous) anastomosis are the most common place to have a ______

anastomosis, venous, stenosis

This is an example of a ______

anastomosis

A NORMAL fistula = a fully _____ fistula

matured

In a fully matured fistula you _____ (should/should not) seen the valves

• PSV = ___-___ cm/s

• Outflow vein = ______

• Volume flow _____ mL/min 

should not, 150-300, pulsatile, >800