[PLTSGT]

One of my patients has swollen arm, cool to touch, and cyanotic fingers--this is on the side of his AVF which has never been used. Surprisingly, his nephrologist is not too concerned. Any thoughts?

[traumaRUs]

Steel syndrome is the first thing that comes to mind:

http://cjasn.asnjournals.org/cgi/content/full/2/1/175

WHile not an emergency, the access surgeon needs to be made aware of this.

[jnette]

Agree.. that's what I thought of as well. You'll actually find this to be a rather common complaint in dialysis patients.

[DeLana_RN]

Agree with pps, this is vascular access steal syndrome. I'm just surprised that the neph is not concerned... I'm sure the vascular surgeon will be!

DeLana

[Lacie]

Originally Posted by DeLana_RN

Agree with pps, this is vascular access steal syndrome. I'm just surprised that the neph is not concerned... I'm sure the vascular surgeon will be!

DeLana

Jmo, I see this with new accesses and I go ahead if it concerns me enough schedule them back for a follow-up with thier vascular surgeon as (at least in my previous clinic) it was the same attitude with the nephro. He'd just pass it off as "normal" for a new access. Countless times it had to be revised or they had an infection brewing. I'd prefer as well as most patients to hear it from the vascular surgeon that it's "normal" particularly if your pt is uncomfortable or in pain. Be sure you document well what you see and what you did and who you told. It's called C-y-a.