Abstract
The effectiveness of hemodialysis is completely dependent on the quality of the patient’s vascular access; thus, appropriate assessment of ateriovenous fistulas and grafts is of critical importance. Point of care ultrasound (POCUS) can be an additional useful skill at the bedside for assessment of the hemodialysis vascular access. In this paper we discuss the basic terminology and techniques that can be employed in the POCUS exam of vascular accesses. We also delineate the current recognized criteria for access maturation and common issues that can be diagnosed with the support of POCUS.
Highlights
Hemodialysis is the most prevalent mode of renal replacement therapy in the United States [1]
In this review we aim to discuss the clinical applications and describe the different techniques involved in point-of-care ultrasound (POCUS) assessment of vascular access in hemodialysis patients
Post-surgical fluid collections such as seromas and hematomas are common and should be identified. Another consideration is that a new fistula often has branch veins which can affect maturation and these should be identified for safe cannulation and potential branch vein ligation
Summary
Hemodialysis is the most prevalent mode of renal replacement therapy in the United States [1]. That the arterial inflow has been examined in the transverse view, the evaluation of the longitudinal view should be completed—the access blood flow will be measured in this step. Post-surgical fluid collections such as seromas and hematomas are common and should be identified Another consideration is that a new fistula often has branch veins which can affect maturation and these should be identified for safe cannulation and potential branch vein ligation. There are three measurements that determine maturation by ultrasound criteria: blood flow, access depth, and access size. The HFM study was a large multicenter observational study, with over 600 patients which showed that AVF blood flow, diameter, and depth at 6 weeks post-surgery predicted AVF clinical maturation. The technique and steps to mark the fistula, identify branch veins and fluid collections, measure blood flow, and measure fistula depth and size are described above in mapping. POCUS in B-mode can identify and localize these collections and help with cannulation and monitoring
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