Assessment & Monitoring of AV Fistulas for New Dialysis Patients

AV fistulas must be assessed and monitored 4-6 weeks after procedure is performed and on a routine basis before each dialysis treatment.

Assessment and monitoring allows for early intervention in the case of AV fistulas failing to mature, early medical intervention in the case of health issues and allows for use of the AV fistula for cannulation during dialysis from as early a point possible (including removal of catheter for vascular access if one was placed).

Baseline assessment of AV fistulas

A baseline assessment must be done by a health worker (i.e. nurse, dialysis technician, physician, etc.) with AV fistula experience, and should be documented in patient record.

Routine assessment

An assessment should be made at each dialysis session, determining changes in baseline, maturation of AV fistula and any problems in AV fistula arm\leg. A physician must be notified immediately in the case of swelling, pain, numbness, steal syndrome, bruising, vein distension, discoloration, etc.

All assessment and monitoring of AV fistulas for the new dialysis patient should be recorded in patient’s medical record.

Health workers assessment and monitoring of AV fistulas should always include:

– Recording of size, shape and visibility of AV fistula.
– Examination of surgical incision and AV fistula site for signs of infection (signs of drainage, redness, fever or tenderness at incision site).
– Inspection of the fistula site for decreased or absence of vein dilatation.
– Listening for adequate bruit with a stethoscope. A continuous low pitched bruit should be present.
– Feeling for palpable thrill at the anastomosis. A continuous purring or vibration should be present, diminishing in strength when further from anastomosis.
– Feeling for a pulse. A strong pulse indicates an obstruction in the blood flow. Pulse should intensify when AV fistula is compressed.
– Checking for complete collapse of vein when arm is elevated above head, indicating that there is no obstruction in the veins.
– All abnormal findings should be reported to physician immediately!

Self-monitoring of the fistula by the dialysis patient:

Self monitoring is an important part of AV fistula care. Patient should be given instruction on:
– Feeling for thrill on a daily basis
– Examining incision site for signs of infection
– Taking care of access
– Immediately reporting all changes to health care team

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