Outpatient Surveillance at the Dialysis Center

Abstract

This chapter details the approach to outpatient hemodialysis access monitoring and surveillance. Close monitoring, evaluation, assessment, and timely intervention can reduce the high rate of primary failure in hemodialysis access. Patient should be seen by healthcare team once every 2 weeks after the surgery, both to assess the progress of maturation process and any complications caused by the creation of access such as tissue ischemia or venous hypertension. Lack of maturation process should direct the focus on determining the cause such as channeling of blood to accessory veins, presence of stenotic area on the target vein, etc. Further diagnostic work such as sonography followed by appropriate intervention usually leads to success. Surveillance is helpful, if conducted properly and focused on the trend of any change. Static Vp and Vp/MAP ratio as well as Ap and ratio is recommended since this can be done every dialysis and does not require any special device. Serial blood flow directly or indirectly may be helpful but requires special device and staff training, and its value is controversial. Upon physical examination, pre-pump Ap and Ap/MAP ratio appear to be more sensitive for AVF and Vp more sensitive for AVG problems. Good access monitoring and surveillance program at the dialysis units and by nephrologists are invaluable in maintaining a well-functioning access.