Strategies for AVF maintenance and preservation of future access sites
| STRATEGY | DESCRIPTION |
|---|---|
| Consistent assessment for a thrill | Patients should be taught to examine for a thrill on a daily basis. If there is loss of thrill or a change in character, they should be advised to present to a vascular access clinic or hospital |
| Avoidance of blood pressure assessment on the AVF arm | Patients should remind health care workers never to take blood pressure readings from the AVF arm as this can compress the outflow vein, potentially causing thrombosis |
| Preservation of the AVF outflow vein | Patients should remind health care workers to avoid IVC or phlebotomy of the AVF outflow vein |
| Preservation of the cephalic and basilic veins of the arm for future access options | Patients should remind health care workers to avoid IVC of the cephalic, basilic, and antecubital veins to preserve future AVF sites, particularly in the nondominant arm as this is preferentially used for AVF creation. Any essential IVC and phlebotomy should occur in the dorsum of the dominant hand where possible |
| Consistent clinical monitoring and surveillance of the AVF | Medical practitioners should perform a brief assessment (history and examination) of the AVF on a consistent basis. If any complications are detected on assessment, this should be followed by duplex ultrasonography to assess for arterial inflow or venous outflow lesions that may be amenable to treatment. Alternatively, patients can also be directly referred to a vascular access service |
AVF—arteriovenous fistula, IVC—intravenous cannulation.