Uploaded byNephroTube - Dr.Gawad
How to examine AVF in 10 minutes - Dr. Gawad
The document outlines a 10-minute process for examining arteriovenous fistulas (AVF) to ensure proper functioning and early detection of complications. Key examination steps include inspecting for infection, hematomas, signs of ischemia, and assessing the AVF pulse character and thrill. Understanding the AVF as a continuous circuit is emphasized to enhance patient outcomes.
In this document
Powered by AI
Presentation introduction by Dr. Mohammed Abdel Gawad on AVF examination, emphasizing the importance of full presentation access.
The importance of AVF examination for patient’s life, stressing early detection of complications to save patients.
Reference to the KDOQI 2006 guidelines for monitoring access.
AVF as a continuous circuit; the examination should encompass the entire arm and beyond, not just the access site.
Steps for examining AVF, including inspection of vascular access scar and anatomy of upper extremity vessels.
Detailed inspection techniques for different types of AVF scars and access sites such as radiocephalic and brachiocephalic AVF.
Different signs to look for including infection signs, hematoma, and ischemia symptoms during AVF examination.
Evaluating aneurysms and performing the arm elevation test to assess inflow and outflow.
The importance of inspecting for central vein stenosis during AVF examination.
Palpation techniques to assess AVF pulse character, thrill, and tests to identify inflow or outflow problems.
In-depth palpitations of AVF including pulse augmentation, sequential occlusion tests, and assessing access vs non-access limb.
Auscultation for detecting abnormalities in AVF, focusing on bruit and heart murmurs indicating complications.
Conclusion of the presentation by Dr. Gawad, thanking attendees.
More Related Content
Similar to How to examine AVF in 10 minutes - Dr. Gawad
How to examine AVF in 10 minutes - Dr. Gawad
- 1. How to examineAVF in 10 minutes Mohammed Abdel Gawad Nephrology Specialist Kidney & Urology Center (KUC) Alexandria – EGY [email protected] 18th KUC Club – 19, Aug, 2016
- 2. To get thepresentation with full animations and videos please contact me on [email protected] For more presentations visit www.NephroTubeCNE.com
- 3. Functioning AVF =Patient’s life =
- 4. AVF Examination: Doseit matter? Early Detection of Complications Semin Dial. 2008;21:269–273.
- 5. Good AVF Examination =Early detection of complications = Saving AVF = Saving patient’s life AVF Examination: Dose it matter? AVF Examination Equation
- 6. Good AVF Examination =Early detection of complications = Saving AVF = Saving patient’s life AVF Examination: Dose it matter? AVF Examination Equation
- 7.
- 8. Important Concept AVF isa continuous circuit Examination should also include the remaining part of arm, shoulder, breast, neck, and face Examination should not be limited to the site of the AV access Don’t think about AVF as it is only anastomosis in the arm. AVF is a continuous circuit which starts at the heart and ends at the heart
- 9. How to ExamineAVF?
- 10. How to ExamineAVF? 1. Vascular access scar site 2. Signs of infection/inflammation 3. Hematoma 4. Signs of ischemia (Steal syndrome) 5. Aneurysm 6. Arm elevation test 7. Collaterals (Central vein stenosis)
- 11. How to ExamineAVF? 1. Vascular access scar site 2. Signs of infection/inflammation 3. Hematoma 4. Signs of ischemia (Steal syndrome) 5. Aneurysm 6. Arm elevation test 7. Collaterals (Central vein stenosis)
- 12. Inspection 1- Vascular AccessScar Anatomy of Upper Extremity Vessels
- 13. Inspection 1- Vascular AccessScar Radiocephalic AVF
- 14. Inspection 1- Vascular AccessScar Snuff-box AVF
- 15. Inspection 1- Vascular AccessScar Brachiocephalic AVF
- 16. Inspection 1- Vascular AccessScar Transposed Basilic Vein AVF
- 17. Inspection 1- Vascular AccessScar Transposed Forearm Cephalic Vein AVF
- 18. Inspection 1- Vascular AccessScar Transposed Forearm Basilic Vein AVF
- 19. How to ExamineAVF? 1. Vascular access scar site 2. Signs of infection/inflammation 3. Hematoma 4. Signs of ischemia (Steal syndrome) 5. Aneurysm 6. Arm elevation test 7. Collaterals (Central vein stenosis)
- 20. How to ExamineAVF? 1. Vascular access scar site 2. Signs of infection/inflammation 3. Hematoma 4. Signs of ischemia (Steal syndrome) 5. Aneurysm 6. Arm elevation test 7. Collaterals (Central vein stenosis)
- 21. Inspection 2- Signs ofInfection/Inflammation ± Pain/Fever
- 22. Inspection 2- Signs ofInfection/Inflammation ± Pain/Fever
- 23. Inspection 2- Signs ofInfection/Inflammation Skin Rash
- 24.
- 25. Inspection 4- Signs ofIschemia (Steal Syndrome)
- 26. Fingers are blueand cold Hand pain rest/exercise Paresthesia Inspection 4- Signs of Ischemia (Steal Syndrome)
- 27. Ulcers Inspection 4- Signs ofIschemia (Steal Syndrome)
- 28. (A) Early chronic ischemiaof hand without tissue loss (hand was cold). (B) Tissue loss at the fingertip is evident (dry gangrene). Inspection 4- Signs of Ischemia (Steal Syndrome)
- 29. How to ExamineAVF? 1. Vascular access scar site 2. Signs of infection/inflammation 3. Hematoma 4. Signs of ischemia (Steal syndrome) 5. Aneurysm 6. Arm elevation test 7. Collaterals (Central vein stenosis)
- 30. How to ExamineAVF? 1. Vascular access scar site 2. Signs of infection/inflammation 3. Hematoma 4. Signs of ischemia (Steal syndrome) 5. Aneurysm 6. Arm elevation test 7. Collaterals (Central vein stenosis)
- 31. Inspection 5- Aneurysms StableAneurysm
- 32. Inspection 5- Aneurysms • Thin,shiny skin • Prolonged leaking • Ulceration • Rapid enlargement Unstable aneurysm (Impending rupture)
- 33. Inspection 5- Aneurysms Thin, shinyskin Unstable aneurysm (Impending rupture)
- 34. Inspection 5- Aneurysms Aneurysms withulceration (arrows; depigmentation with early skin break-down). Unstable aneurysm (Impending rupture)
- 35. Inspection 6- Arm ElevationTest Inflow Outflow
- 36.
- 37. Inspection 6- Arm ElevationTest Normally: Collapse
- 38. Inspection 6- Arm ElevationTest Outflow Stenosis Normally: Collapse
- 39. Inspection 7- Central veinstenosis
- 40. Inspection 7- Central veinstenosis
- 41. Inspection 7- Central veinstenosis Early, subcutaneous collaterals
- 42. How to ExamineAVF?
- 43. How to ExamineAVF? Inflow Outflow Feel to detect outflow or inflow problem 1. AVF Pulse Character 2. AVF Thrill 3. Pulse Augmentation Test 4. Sequential occlusion test 5. Access vs Non Access Limb
- 44. How to ExamineAVF? Inflow Outflow Feel to detect outflow or inflow problem 1. AVF Pulse Character 2. AVF Thrill 3. Pulse Augmentation Test 4. Sequential occlusion test 5. Access vs Non Access Limb
- 45.
- 46. Palpation 1-AVF Pulse Character OutflowStenosis Hyperpulsatile, Water-hammer
- 47. Palpation 1-AVF Pulse Character OutflowStenosis Inflow Stenosis Hypopulsatile, Feeble, FlatHyperpulsatile, Water-hammer
- 48.
- 49. Palpation 2-AVF Thrill Abnormally: DiscontinuesThrill (Systolic only) Outflow Stenosis Strong, Localized Normally: Continues Thrill
- 50. Palpation 2-AVF Thrill Outflow Stenosis Strong,Localized Weak, not localized Inflow Stenosis Abnormally: Discontinues Thrill (Systolic only) Normally: Continues Thrill
- 51. Palpation 2-AVF Thrill Examine thrillfrom anastomosis all way to chest wall Outflow Stenosis Strong, Localized Weak, not localized Inflow Stenosis Abnormally: Discontinues Thrill (Systolic only) Normally: Continues Thrill
- 52. How to ExamineAVF? Inflow Outflow Feel to detect outflow or inflow problem 1. AVF Pulse Character 2. AVF Thrill 3. Pulse Augmentation Test 4. Sequential occlusion test 5. Access vs Non Access Limb
- 53. How to ExamineAVF? Inflow Outflow Feel to detect outflow or inflow problem 1. AVF Pulse Character 2. AVF Thrill 3. Pulse Augmentation Test 4. Sequential occlusion test 5. Access vs Non Access Limb
- 54.
- 55. Palpation 3-Pulse Augmentation Test Normally:Pulse augmentation, Absence of Thrill
- 56. Palpation 3-Pulse Augmentation Test Normally:Pulse augmentation, Absence of Thrill No Pulse augmentation
- 57. Palpation 3-Pulse Augmentation Test NoPulse augmentation, No thrill = Inflow stenosis No Pulse augmentation
- 58. Palpation 3-Pulse Augmentation Test NoPulse augmentation, No thrill = Inflow stenosis No Pulse augmentation, Normal thrill = Accessory Vein(s) No Pulse augmentation
- 59. Palpation 3-Pulse Augmentation Test NoPulse augmentation, No thrill = Inflow stenosis No Pulse augmentation, Normal thrill = Accessory Vein(s) Sequential occlusion test No Pulse augmentation
- 60. Palpation 4-Sequential occlusion test Todetect the level of accessory veins Still No Pulse augmentation, Normal thrill Augmentation, No thrill = Level of accessory vein detected
- 61. How to ExamineAVF? Inflow Outflow Feel to detect outflow or inflow problem 1. AVF Pulse Character 2. AVF Thrill 3. Pulse Augmentation Test 4. Sequential occlusion test 5. Access vs Non Access Limb
- 62. How to ExamineAVF? Inflow Outflow Feel to detect outflow or inflow problem 1. AVF Pulse Character 2. AVF Thrill 3. Pulse Augmentation Test 4. Sequential occlusion test 5. Access vs Non Access Limb
- 63. Palpation 5-Access vs NonAccess Limb Test Suspected Abnormality Temperature Warm + swelling = infection Cold = Steal syndrome Grip strength Steal syndromeRange of motion Sensory loss
- 64. How to ExamineAVF?
- 65. How to ExamineAVF?
- 66.
- 67. Auscultation 1-Bruit Abnormally: Discontinues Thrill(Systolic only) Outflow Stenosis High Pitched, Loud Normally: Continues Thrill
- 68. Auscultation 1-Bruit Continues Thrill Discontinues Thrill(Systolic only) Outflow Stenosis Inflow Stenosis High Pitched, Loud Low Pitched, Quiet Abnormally: Discontinues Thrill (Systolic only) Normally: Continues Thrill
- 69. Auscultation 1-Bruit Continues Thrill Discontinues Thrill(Systolic only) Outflow Stenosis Inflow Stenosis High Pitched, Loud Low Pitched, Quiet Auscultate AVF from anastomosis all way to chest wall Abnormally: Discontinues Thrill (Systolic only) Normally: Continues Thrill
- 70. Auscultation 2-Heart For early detectionof newly formed murmurs (?? infective endocarditis)
- 73.