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Pt referred Chronic Hemodialysis (HD) - PowerPoint PPT Presentation


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Hemodialysis (HD) Flow Chart. * Rules for Access Placement - Upper extremity > lower extremity - Nondominant extremity > dominant extremity - Nonpacemaker > pacemaker side - Distal > proximal - Superficial > deep vein (may need superficialization) - Diameter > 3 mm per U/S image .

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Hemodialysis (HD) Flow Chart

* Rules for Access Placement

- Upper extremity > lower extremity

- Nondominant extremity > dominant extremity

- Nonpacemaker > pacemaker side

- Distal > proximal

- Superficial > deep vein (may need superficialization)

- Diameter > 3 mm per U/S image

Pt referred Chronic Hemodialysis (HD)

No

Does pt have potential living LD?

Yes

Pt on HD?

Yes

No

Is Cr Cl >15?

Yes

No

Life expectancy  6 months?

Workup for LD renal tx

No

Is patient symptomatic?

No

  • Consider superficialization
  • Ligation of collaterals

Yes

Yes

Workup for chronic HD*

Place Ash-Split catheter

Start HD

Ultrasound

Yes

No

No

Is fistula maturing?

Continuous vein present?

Yes

Surgery for AVF

AVF possible?

  • D/C Coumadin
  • Continue ASA & Plavix

Yes

No

Surgery for PTFE graft