Project - Self Examination of AV Fistula using Stethoscope – 7 STEPS
- Teach patients to identify their type of fistula
- Train them about basic use of stethoscope
- Make them listen the “Continuous Bruit” over a functioning fistula – name it “Continuous Sound”
- Compress fistula distally to mimic upstream stenosis – and make them listen the “Systolic Bruit” over a functioning fistula – name it “Interrupted sound”
- Tell – what to do if sound is “interrupted” ?
- Pre and post evaluation to asceses training success
- Validate their self examination findings with every routine clinical follow up visits.
Consent have been given by patient and relatives to use this video for educational purpose
Point of caution
1. In event of low BP – a continuous sound may turn into interrupted sound.
2. What to do in case of “interrupted sound”
3. Do not panic –fistula is not blocked, it just might be narrow.
4. Check BP – if its low – recheck after some time when BP is better
5. If interrupted sounds persist – contact AVF surgeon early.
6. This Method is made to only detect severe stenosis – mild to moderate stenosis will have “continuous sound”.
7. No Sound reflects fistula thrombosis & is an Emergency
Self AV Fistula Examination: Monitor Your Fistula at Home
For dialysis patients, having a functioning AVF is critical to their success on dialysis. Educating patients on how to perform a Self AV Fistula Examination allows them to be their own advocates by monitoring their access to detect complications and care for their AVF to prolong its life. We at AVF Care Workshops are dedicated to teaching patients how to perform a successful, effective, and simple Self AV Fistula Examination.
Why Self AV Fistula Examination Matters
Self AV Fistula Examination regularly allows patients to spot any changes in the appearance of their AV fistula/ graft that could indicate that the fistula/ graft has narrowed or formed clots. Finding issues at an early stage will help stop any serious consequences of these problems and decrease the patient’s visit to go to the emergency room for an intervention. Patients who consistently self-examine their AV fistula/ grafts are better equipped to report any problems they encounter to their dialysis team or vascular access surgeon.
Self AV Fistula Examination: Simple Steps for Patients
The process of Self AV Fistula Examination is easy to learn and can be done at home by following a few simple steps:
- Know your fistula type:
Find out whether your fistula is radiocephalic, brachiocephalic, or brachiobasilic. Knowing the type of fistula you have helps you understand where to examine it properly for regular monitoring. - Learn how to use a stethoscope:
You will be taught how to correctly hold and place the stethoscope over your fistula so that you can clearly hear the blood flow. - Listen for a continuous sound:
Use the stethoscope to listen for a continuous bruit, which indicates that blood is flowing normally through your fistula. - Mimic gentle downstream compression:
By gently squeezing the distal (lower) end of your fistula while listening with the stethoscope, you can simulate a condition similar to thrombosis. This will cause the sound to become interrupted. - If the sound changes, do not panic:
A change or interruption in sound does not always mean a serious problem. It may occur due to low blood volume, reduced blood flow, or changes in blood pressure. Monitor your blood pressure (BP), and if you notice the sound change again, recheck your BP once it is stabilized. - Regularly validate your self-examination with your doctor:
Sharing your self-examination findings with your doctor helps in accurate monitoring and long-term care of your fistula. - Emergency alert:
If you are unable to hear any sound at all or notice no response, contact your healthcare provider immediately, as this may indicate a blocked (thrombosed) fistula.
As stenosis becomes critical – this sound progresses to low pitch – systolic only bruit
Points of Caution During Self AV Fistula Examination
- When blood pressure drops, the constant sound that is associated with the AV Fistula may become temporarily interrupted (rather than being continuous). Mild to moderate levels of narrowing in an AV Fistula usually produce a continuous sound; therefore, some Self AV Fistula Examination will only detect severe narrowing of an AV Fistula.
- If a person has persistent interrupted sounds, they should be evaluated by the patient’s AVF surgeon promptly.
Training and Evaluation
Every patient who learns how to do a Self AV Fistula Examination has been pre- and post-evaluated to verify they can detect any alteration of their AVF. This means that through actual training with a stethoscope and having an AVF surgeon provide encouragement, patients have been or are prepared to check on their own vascular access without feeling insecure or unqualified to do so.
Conclusion
For dialysis patients, mastering how to perform Self AV Fistula Examination is a vital skill. Self-examination helps ensure safety and encourages patients to be actively involved in their own care while allowing for early detection of problems or complications with the fistula. Ongoing monitoring by the patient through self-examination, execution of a self-examination using the correct technique, and prompt reporting of any abnormalities found during self-examination will lead to improved outcomes from dialysis treatments and a healthy AV fistula.
FAQs
How often should I perform Self AV Fistula Examination?
It is suggested to examine your fistula daily or just before your next dialysis appointment.
Can low blood pressure affect the sounds during Self AV Fistula Examination?
Yes, if your blood pressure is low, it could make your continuous sound like an interrupted sound. When your blood pressure returns to normal, you should recheck your examination.
What should I do if there is no sound?
If you do not hear anything when examining your AV Fistula/ graft, it likely means you have a blood clot. You should contact your doctor as soon as possible.
Can mild stenosis be detected by Self AV Fistula Examination?
Self-examinations can usually detect severe levels of stenosis, while mild to moderate levels of stenosis generally produce a continuous sound.
