Wide open fistulas that don't work

[AcuteHD]

Uggg! Don't you hate the blame game that happens when a pt that comes back from having their access "fixed" but it doesn't work? Vascular is always like, "It was wide open for us are you sure you stuck him in the right spot?" and we are like, "We've been sticking this pt for years, yes. It does not work." This may not be the best forum to ask, but I would really like to understand what's going on from the vascular side. How does this happen?

[foxy1112]

Stenosis problem probably?

[AcuteHD]

A stenosis develops slowly. If vascular says it's "wide open" I take that to mean good blood flow from end to end, no clots or stenosis.

[Chisca, RN]

Ask for flow numbers. What is the actual flow, in ml/ minute, that you documented that you measured? Injecting dye and seeing it whiz by under fluoroscopy doesn't work for me. Also, what is the diameter, in millimeters, of the fistula?

[WINDYCITYRN]

We get pts post plasty or revision. Vascular marks two spots for us to cannulate. We just make sure we feel a thrill or hear a bruit before we cannulate. Luckily we were always able to cannulate and the pt goes home the next day. I had another pt who is a very difficult stick and whose fistula just never developed fully. Vascular kept saying its functional but even with a tight turniquet it was barely palpable. He ended up getting another fistula.

[Chisca, RN]

. Vascular kept saying its functional...

Just the numbers, please. If you can't tell me, in millimeters, what the size of the vessel is then you have no business telling me to attempt to place a 15g needle in it. 2D ultrasound can easily confirm the size of a fistula. Less than 6mm is a no go. We have a attending vascular surgeon who instructs residents that if you can palpate it you can canulate it. I refuse to torture patients and instruct them why it is poor practice to judge the patency of a fistula by how lucky a dialysis nurse is with a needle.