561321
Description
Flashcards by ecmarchese, updated more than 1 year ago
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Created by ecmarchese
almost 11 years ago
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| Question | Answer |
| Method of removing toxic substances from blood when the kidneys are unable | Dialysis |
| What is a life saving technique for pts with acute and chronic kidney failure? | Dialysis |
| This circulates blood through special filters to remove toxins. | Hemodialysis |
| What is necessary for a successful hemodialysis? | Access to the vascular system |
| A AV fistula must support velocities as high as _____ thus a peripheral IV will not work! | 250 ml/min |
| What are the graft flow volumes? | <250- poor, 300-1000 normal, >1400- too high! |
| What is the flow volume equation? | Q=area x mass vel. X 60 sec |
| This involves the surgical joining of an artery and vein under the skin | AV fistula |
| Once the fistula is in place, what will happen to it? | The vein will stretch due to high velocities |
| Why are native veins not used in dialysis? | They are not suitable for AV fistulas so a graft is implanted |
| What are two things they could use as donor veins while creating a fistula? | Own sap heinous vein, bovine carotid artery, synthetic graft |
| What are 3 types of grafts and fistula? | Fistula, access grafts, common loop |
| Aka Brescia cimino fistula | Fistula |
| What arm are fistula generally put in? | Non dominate arm |
| What are the types of fistulas? | Radial artery to cephalic vein, ulnar artery to basilic vein |
| What is the most common type of fistula? | Radial artery to cephalic vein |
| What is the benefit of a fistula? | Long term latency and low complication rate |
| What are the types of access grafts? | Common straight, common loop |
| What are 3 types of access grafts? | Synthetic, gortex, or donor |
| This is when a vessel connects straight from artery to vein. | Common straight |
| What are some examples of a common straight? | Distal radial artery to cephalic, distal radial to median cubital, distal radial to basilic, distal brachial artery to proximal basilicoaxillary vein |
| What are some examples of a common loop graft? | Distal brachial artery to cephalic vein, distal brachial artery to median cubital vein, distal brachial artery to basilic vein, proximal brachial artery to ancillary vein, superficial femoral artery to greater saphenous |
| What do pts with a long term dialysis graft have to do? | Have multiple grafts put in due to the short patency of grafts |
| What are the complications of a graft, and or the indicators to asses the graft? | Thrombosis, stenosis, infection, arterial steal, distal venous hypertension, aneurysms/ pseudoaneurysms |
| Another word for occlusion | Thrombosis |
| Where do stenosis generally occur in a fistula or graft? | Prox/ distal anastomoses, center |
| Digits/ hand ischemia | Arterial steal |
| Are aneurysms and pseudo aneurysms common in grafts and fistulas? | Yes |
| What type of transducer do you use for a hemodialysis graft? | 7.5-10 MHz |
| Do you ever take a BP over dialysis graft? | No |
| This will have a palpable thrill due to high velocities? | Hemodialysis graft |
| What is the evaluation protocol for hemodialysis grafts? | Document with 2d and Doppler the native inflow artery, arterial anastomoses, body of grafts (prox, mid, distal), venous anastomoses, native outflow vein |
| What are you looking for during you evaluation of the hemodialysis graft? | Aneurysms, leaks, peri graft fluid collections, stenosis, occlusions |
| Arterial inflow proximal to the graft/ fistful as should demonstrate low resistant waveforms. | Native artery doppler |
| Arterial flow should remain low resistant but velocities may be increasing and spectral broadening may be noted. | Proximal arterial graft anastomoses Doppler |
| What do you obtain in Doppler when looking at the graft? | Obtain systolic velocities prox, mid, distal |
| What should flow in the graft look like in Doppler? | Mixture of arterial and venous characteristics with turbulence and spectral broadening |
| Are stenosis in the distal anastomoses common? | Yes |
| Once you have obtained the distal portion of the graft, what do you move on to next? | Distal graft venous anastomoses |
| The native vein which has become arterialized is often referred to as ? | Efferent and afferent |
| What do you evaluate for in the native venous outflow/ efferent vein? | Doppler distal to the anastomoses, demonstrate compressibility, evaluate for thrombus, obtain velocities in native cephalad to the graft in upper arm, flow should return to normal here |
| A stenosis in the native venous outflow/ efferent vein is commonly caused by? | Neo intimal hyperplasia |
| What are you assessing the peri graft/ fistula tissue for? | Hematoma, aneurysm, pseudo aneurysm |
| This is a occurrence where the fistula graft will steal blood from the hand | Arterial steal |
| How do you assess for a arterial steal? | Obtain digit pressures, compare both to as symptomatic hand |
| What does a absent thrill indicate? | Occlusion |
| What will a stenosis in a fistulas/ graft look like? | Region of extremely high velocities |
| Do grafts and fistulas have a high failure rate? | Yes |
| What are the guidelines for a normal graft/ fistula? | High systolic velocities- 100-400 cm/s, high diastolic velocities- 60-200 cm/s |
| What will the flow pattern of a normal graft/ fistula look like? | Disorganized with spectral broadening |
| What are some indications of an occlusion? | No flow in graft with color or Doppler, no flow in efferent vein distal to fistula, high resistance in artery leading into fistula, low/ diminished venous outflow |
| What is the criteria for dialysis graft stenosis? | Mild- velocity increase <50% of preceding segment, moderate- velocity increases between 50-90% of preceding segment! severe- velocity increases > 100% of preceding segments |
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