Hi,
Could anyone tell me about placement for a dialysis access fistula? I can’t seem to find any information about exactly where they are placed and what choices the patient has. Thanks for any help you can give.
Check out Kidney School (http://www.kidneyschool.org) and Module 8 on vascular access. You can work through this module interactively which will give you an “action plan” based on your answers to questions throughout the module. The site doesn’t ask you to register and it doesn’t save what you enter so your privacy is protected. Another option is to download the PDF of the whole module. This is only one of the many topics covered on Kidney School.
Beth,
Thank you for a great site! It has a lot of stuff that I have been looking for, but it still does what every other site says and only generally gives an idea about actually where the fistulas are placed. I know the arms, legs and chest, but not really where and what options the patient may have. Can you suggest other sites?
Thanks!
The best way to assure successful placement of a fistula is to have vein mapping. This shows vessels that are the best to use. Here’s information on vein mapping:
http://www.svunet.org/about/positions/UEvein_mapping%20_final_3_11_03.pdf
Most fistulas and grafts are placed in the lower arm between the bend in the elbow and the wrist. They are usually placed in the patient’s non-dominant arm. The patient needs to be sure to tell the surgeon which is his/her dominant arm – the one he/she uses to write and do most activities. If it’s not possible to place the fistula or graft in the lower arm, then the surgeon usually looks at placing it in the upper arm. The next most common place is in the thigh. Catheters are the last choice of access, except for emergency access or if a patient cannot have a graft or fistula for some reason. These are placed in the upper chest.
Here are patient education resources that are recommended by the Fistula First initiative:
http://www.fistulafirst.org/pdfs/patientresources.doc
Here’s an educational offering for physicians about vascular access placement that is part of the Fistula First initiative:
http://cme.ouhsc.edu/5E016webtropages.htm
Here’s information on Dr. Vo Nguyen and tips for fistula placement based on his success:
http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/ImprovementStories/BoostingAVFistulaAccessinESRDPatients.htm
In the Vascular Access module of the Core Curriculum for the Dialysis Technician, which you can download from the Medical Education Institute website (http://www.meiresearch.org), there is a description of which veins and arteries can be used to make an AV fistula.