Physical Examination as a Tool for Hemodialysis Vascular Access Surveillance

Introduction: Physical Examination (PE) of the arteriovenous (AV) access is of established clinical importance.The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend that PE of the AV access should be performed by a qualified individual on regular basis (at least monthly) when used for surveillance.The primary purpose of this examination is to detect vascular stenosis or other abnormalities that might lead to access dysfunction.This can be done with levels of accuracy that are quite acceptable.In contrast to other approaches to AV access surveillance, it is simple to perform and does not require additional machines, regular calibrations, additional cost, or additional staff.In addition PE can also detect other problems that can adversely affect the AV access.For these reasons, plus the fact that it is easily learned, PE should be taught to all hemodialysis caregivers and should be performed on a regular basis on all hemodialysis patients. Purpose of this study:• The purpose of this study was to evaluate the accuracy of physical examination in the detection and location of AV access stenosis when compared with angiography.• To reflect the importance of PE in prevention of vascular access dysfunction. Results:• There was strong agreement between physical examination and angiography in the diagnosis and localization of outflow and inflow stenosis.• In addition to the detection of stenosis, pinpointing the location of stenosis on physical examination has important procedural implications.