Heed the Herald Bleed: An Ominous Warning for Potential Vascular Access Rupture. Prepared by Pauline Byrne CNS Vascular Access Coordinator Renal Centre, Wollongong, ISHLD. Heed the Herald Bleed……… and ACT!!.
Pauline Byrne CNSVascular Access CoordinatorRenal Centre, Wollongong, ISHLD
Look- Visual Inspection
Feel-Palpate Thrill and Pulse
Listen- Character of Bruit
Observe- Access re Pressure Trends during Haemodialysis Treatment.
Examine Skin Integrity -
Aneurysm formation in primary fistulae can be due to–
PseudoaneurysmsWhy You should not cannulate into Aneurysms & Pseudoaneurysms........
Aneurysms as they enlarge
compromise the overlying
skin of the fistula, and for those patients where skin layer is thin and prone to infection, is a sign of impending perforation.
There is no vessel nor graft in dilated wall- only skin + subcutaneous tissue.
*Indicators for identifying stenosis*
Risk of Access Failure: Fistula flow < 500 mls/min Graft < 600 mls/min.
Trends and setting of individual thresholds advised.
e PTFE Grafts for Haemodialysis’, Biomedical Papers of the Medical
Faculty of Polacky University in Olomouc,Czech Republic,pp.13-19
Fistula in a Chronic Dialysis Patient’, The Journal of Emergency Medicine,pp.224-225
Director Renal Services, Illawarra and Shoalhaven Area
Nephrologists, Wollongong Renal Centre
Vascular Surgeons, Wollongong