By Ingemar Davidson

This ebook is meant as a advisor to universal diagnostic, operative and percutaneous options utilized in developing and retaining vascular entry for hemodialysis. whilst writing the textual content, the authors have interested by surgeons in education, fellows, interventional radiologists and clinically energetic nephrologists. Dialysis nurses and different clinicians fascinated about the care of finish level renal affliction and dialysis sufferers also will vastly reap the benefits of this guide. This 2d variation of the textual content includes increased sections on ESRD, entry surveillance and surgical and diagnostic units, in addition to new sections on peritoneal and twin lumen catheter placement, normal medications and dialysis, hemo- and peritoneal dialysis concepts and CPT and ICD coding for statistical and billing reasons. those alterations mirror the hugely technical nature of medical administration during this evolving uniqueness.

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23. 24. Mark radial artery and cephalic vein and dorsal branch. Skin incision between the radial artery and cephalic vein. Dissect cephalic vein and the dorsal branch. Place vessel loops. Cut through the fascia on top of the radial artery. (DO NOT dissect on either side of the radial artery to avoid bleeding from the concomitant veins). Expose the radial artery from the top, where there are no branches. Gently push the peri-adventitial tissue sideways exposing the paired small arterial branches.

12B). The first back wall suture and all subsequent back wall sutures go inside-out on the opposite vessel and outside-in on the vessel nearest the surgeon (Fig. 12C). In these illustrations, the surgeon is on the ulnar site closest to the radial artery. The stitches closest to each corner are placed taking small bites (1 mm) of the vessels with minimal travel. This will maximize blood flow and preserve lumen size by preventing a purse-string effect. Large bites in the corners jeopardize the very survival of the fistula.

Occasionally patients are dialyzed “backwards,” making dialysis very ineffective because of recirculation. Should the direction of flow be unknown, it is very easy to compress the graft midway at the apex of the loop to determine on which side the pulse disappears and the direction of flow. When the graft is clotted it is harder to determine the anastomosis anatomy without prior knowledge. The patient will usually know which side is arterial (pull) or venous (return). Fig. 9. The direction of tunneler insertion (A and B), the tapered vascular graft insertion direction (C) and the second portion of the loop placement (D).

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