49 yrs old male with past medical history of DM, HTN, IHD
ESRD, started dialysis and has right side SCV perma-cath for 4 weeks
What would be your assessment and approach please
What would be your AV access planning
49 yrs old male with past medical history of DM, HTN, IHD
ESRD, started dialysis and has right side SCV perma-cath for 4 weeks
What would be your assessment and approach please
What would be your AV access planning
Full history include medication and smoking
Examination vital signs comment on BP bilaterally.
Integrity of palmar arch by allens test
Any signs of CVO
Upper limbs non dominant and distal as possible
Counsilling the pt sbout procedure and type of anesthiae
Full labs
Cardiac assessement and fitness
Bilateral upper limbs and central neck veins duplex
Q1.
Full history include medication and smoking
Examination vital signs comment on BP bilaterally.
Integrity of palmar arch by allens test
Any signs of CVO
Upper limbs non dominant and distal as possible
Counsilling the pt sbout procedure and type of anesthiae
Full labs
Cardiac assessement and fitness
Bilateral upper limbs and central neck veins duplex
Thanks for your answer, I believe for assessment of central veins it is better to ask for venogram or CTV
As he has a history of IHD, I will discuss with the cardiology team if he is a candidate for a fistula or not. Then, I will ask the patient, what is his dominant arm. If it is right hand I will scan his Lt arm for suitable site for AV fistula. If not suitable or he is left handed, so I will examine the Rt hand but it would be preferable to change the insertion site of the current perma-cath to Lt SCV or Lt IJV.
Very good approach
What would be your assessment and approach
I will examine the upper limb of the patient starting from non dominant side and distally before proximally
i will ask for duplex scan on both Upper limbs with comment on the caliber of the superficial veins distance from skin and distance from the artery flow inside the artery .
I will consult the cardiologist for the cardiac state of the patient.
I will discuss with the patient the AVF procedure under local anesthesia if there’s suitable vein otherwise i will plan for AVG
What would be your AV access planning
if there’s suitable vein Left Radio-cephalic AVF would be ideal
Very good methodical approach, I would encourage you to develop skills to use USS to do it on clinic yourself
1 ecg echo cardio consultation for cvs preparation
2 hx medical surgical drug hx antiplt or anti hypertensive
Occupation dominant hand
I would like to consider replacement of permanent cath in other site other than scv for fear of cvo
3clinical examination chest any dil veins any signs of cvo peripheral pulsatiin?? Vasculitis any previous scars
duplex scanning both ul for detection suitable veins
Full lab CBC, inr
Planning avf distal Lt rc
But ptn is DM???
Very good answer, I agree with you diabetics above 45 may have some issues with durability of RC AVF
It all depends on USS findings and clinical assessment