art-gu_fistula maturity staff dialysis professional

7/25/2019 ART-GU_Fistula Maturity Staff Dialysis Professional

1/15

Weeks 1-2: Fistula Maturity Check

Dialysis Professional

Ready, Set, Go The Steps to Catheter Freedom

Perform fistula maturity check at each treatment or when patient reports a change.

Reinforce to patient the importance of daily fistula checks.

Listen to the patient.

Were there any abnormal findings during the fistula maturity check?

Look FeelListen

Document that there wereno abnormal findings.

No

Document findings andrefer to expert clinician.

Yes

Continued..


2/15

The dressing is clean and dry.

The skin around the dressing looks like it didbefore surgery.The hand looks the sameas itdid before surgery.

When the dressing is no longer needed, thesurgery site is clean and dry.

Once it has healed, the skin over the fistulais all one colorand looks like the skin aroundit.

You can feel the fistula. You cannot feel the fistula.The hand of the affected arm is cold to thetouch.

The bruit isaudible.

Bruit: Listen with a stethoscope over the anastomosis.This is where the artery is joined to the vein.

The dressing is wetor soiled.There is drainageon the dressing.

The arm is bruisedand/or the hand is not thenormal color.

There is redness, swelling, or drainage.

There isredness, swelling, ordrainage.

There is no sound or the bruit is not as loudas the last time it was checked.

Look

Feel

Listen

Continued..

G





3/15

This publication was developed under Contract NumberHHSM-500-2013-NW002C, titled End Stage Renal DiseaseNational Coordinating Center (ESRD NCC), sponsored by

the Centers for Medicare & Medicaid Services (CMS),Department of Health and Human Services. The contents

presented do not necessarily reflect CMS policy.

www.esrdncc.org

Feel

Thrill:A vibration or buzz that can be felt mostprominently over the anastomosis; it will diminish

along the length of the fistula.

G




The thrill becomes strongeras the fistulamatures.

Pulseis a slight beating that feels like aheartbeat. Fingers placed lightly on thefistula should move slightly.

You cannot feel the thrillor it is weaker thanthe last time it was checked.

Pulsatile:The beat is strongerthan a normalpulse.Fingers placed lightly on the fistularise and fall with each beat.


4/15

Week 3: Fistula Maturity Check








No


Yes

Continued..

Look FeelListenArm Elevation test

(AVF Only)


5/15

The hand looks the sameas it did beforesurgery.

The surgery site isclean and dry.The skinover the fistula is all one color and looks likethe skin around it.

You canfeel the fistula.

The cannulation segment is long enough touse two needles placed two inches apart.

You cannot feel the fistula,and/or theaffected hand is cold to the touch.

The bruit is audible.

The bruitsounds like a whoosh or forsome, like a drumbeat.



There is redness, swellingor drainage.

There is no sound,or the bruit is not as loudas the last time it was checked.

Sound is differentfrom that of a normalbruit.

Look

Feel

Listen

Continued..

G







Pulse:A slight beating that feels like aheartbeat. When you place your fingerslightly on the fistula, they move slightly.

Thrill: You cannot feelthe thrill, or it is weak-erthan the last time it was checked.

Pulsatile:The beat is stronger than a normalpulse. Fingers placed lightly on the fistularise and fall with each beat.


6/15

Lower Arm Fistula

The fistula outflow vein collapseswhen thearm is raised above the level of the heart.

Upper Arm FistulaThe fistula outflow vein partiallycollapseswhen the arm is raised above thelevel of the heart. It may feel flabby whenpalpated.

Lower Arm Fistula

The fistula outflow vein does not collapseafter the arm is raised above the level ofthe heart. This may mean there is a problemallowing the blood to flow from the fistula.

Upper Arm FistulaThe fistula outflow vein does notpartiallycollapseor become flabby after beingraised above the level of the heart. This maymean there is a problem allowing the bloodto flow from the fistula.

Arm Elevation




www.esrdncc.org

DistendedStenosis

Collapsed

G





7/15








Look FeelListen


No


Perform once.If normal, no need to

repeat.

Yes

AugmentationTest

Arm Elevation test(AVF Only)

Continued..


8/15


The surgery site is clean and dry. The skinover the fistula is all one colorand looks likethe skin around it.

You can feel the fistulaand identify thecannulation segment.The cannulation segment is long enough touse two needles placed two inches apart.

You cannotfeel the fistula.You cannotfeel the cannulation segment.

The bruit is audible.You hear the bruit along the cannulationsegment.

The bruit sounds like a whoosh or, forsome, like the beat of a drum.



There isredness, swelling, or drainage.

There is no sound, or the bruit is not as loudas the last time it was checked.

Sound is differentfrom what a normal bruitshould sound like.

Look

Feel

Listen

Continued..

G






The thrill becomes stronger as the fistulamatures.

Pulse:A slight beating that feels like aheartbeat. Fingers placed lightly on thefistula move slightly.

Thrill:You cannotfeel the thrill, or it isweakerthan the last time it was checked.

Pulsatile:A Pulsatile beat is one that isstrongerthan a normal pulse. Fingers placedlightly on the fistularise and fall. with eachbeat.


9/15

Lower Arm Fistula


Upper Arm FistulaThe fistula outflow vein partiallycollapseswhen the arm is raised above the level of theheart. It mayfeel flabbywhen palpated.

Pulse is strong and boundingand maycause your finger to rise and fallwith each

beat.

Pulse does notbecome more forceful orstrong and bounding.

Lower Arm Fistula

The fistula outflow vein does notcollapseafter the arm is raised above the level ofthe heart. This may mean there is a problemallowing the blood to flow from the fistula.

Upper Arm Fistula

The fistula outflow vein does not collapsepartially or become flabby after beingraised above the level of the heart. This maymean there is a problem allowing the bloodto flow from the fistula.

Arm Elevation

Augmentation Test

Occlude Access

Place your fingers on the out-going vein, feel the pulse, and press downuntil no blood is flowing through the access.

Palpate Pulse

Keep your finger on the vein and feel for the pulse near the arterialconnection of the fistula.




www.esrdncc.org

DistendedStenosis

Collapsed

G





10/15









No


Yes

Continued..


(AVF Only)


11/15

The hand looks the sameas it did beforesurgery

The skin over the fistula is uniform inappearanceand looks like the skin around it.

You can feelthe fistula and identify thecannulation segment.

The cannulation segment is long enough touse two needles placed two inches apart.

You cannotfeel the fistula.

You cannot feel the cannulationsegment.

The bruit is audible,and can be heard alongthe cannulation segment.

The bruit sounds like a whoosh, or forsome, like a drum beat.



There is redness, swelling,or drainage.


Sound is differentfrom what a normal bruitshould sound like.

Look

Feel

Listen

Continued..

G





12/15

Lower Arm FistulaThe fistula outflow vein collapseswhen thearm is raised above the level of the heart.

Upper Arm Fistula

The fistula outflow vein will collapsepartiallywhen the arm is raised above the level of theheart. It may feel flabby when palpated.

Lower Arm FistulaThe fistula outflow vein does not collapseafter the arm is raised above the level of theheart. This may mean there is a problemallowing the blood to flow from the fistula.

Upper Arm Fistula

The fistula outflow vein does not collapsepartially or become flabbyafter beingraised above the level of the heart. This maymean there is a problem allowing the bloodto flow from the fistula.

Arm Elevation




www.esrdncc.org

Feel

Thrill:A vibration or buzz that can be felt most

prominently over the anastomosis; it will diminishalong the length of the fistula.

DistendedStenosis

Collapsed

G




The thrill becomes stronger as the fistulamatures.

Pulse:A slight beating that feels like aheartbeat. Fingers placed lightly on thefistula move slightly.

You cannotfeel the thrill or it is weakerthanthe last time it was checked.

Pulsatile:The beat is strongerthan a normalpulse.Fingers placed lightly on the fistulawill rise and fall with each beat.


13/15









No


Yes

Continued..

Expert Clinician:Assess each access monthly or more often if problems

are reported.


(AVF Only)


14/15


The skin over the fistula is uniform inappearanceand looks like the skin around it.

The bruit is audible.

You hear the bruit along the cannulation

segment.

The bruit sounds like a whoosh,or forsome, like a drum beat.



There is redness, swellingor drainage.


Sound isdifferentfrom what a normal bruitshould sound like.

Look

Feel

Listen

Continued..

G

Thrill:A vibration or buzz that can be felt mostprominently over the anastomosis; it will diminishalong the length of the fistula.





Pulse:A slight beating that feels like aheartbeat.Fingers placed lightly on thefistula move slightly.

You cannotfeelthe thrill or it is weakerthanthe last time it was checked.

Pulsatile:The beat is strongerthan a normalpulse.Fingers placed lightly on the fistularise and fall with each beat.


15/15

Lower Arm Fistula


Upper Arm FistulaThe fistula outflow vein partially collapseswhen the arm is raised above the level of theheart. It mayfeel flabbywhen palpated.

Lower Arm Fistula

The fistula outflow vein does not collapseafter the arm is raised above the level ofthe heart. This may mean there is a problemallowing the blood to flow from the fistula.

Upper Arm FistulaThe fistula outflow vein does not collapsepartially or become flabbyafter beingraised above the level of the heart. This maymean there is a problem allowing the bloodto flow from the fistula.

Arm Elevation




www.esrdncc.org

DistendedStenosis

Collapsed

G




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