Discover and read the best of Twitter Threads about #vascularaccesspearls

Most recents (5)

💥’Dialysis AV Fistula & the Heart:
Friend or Foe?’ - Tweetorial

⚡️Let’s review the following:
☄️Hemodynamic effects of an AVF
☄️Impact of AVF on Cardiac Structure
& Function
💥Why is it important to understand the impact of AVF on the heart?
⚡️Because AVF use has ⬆️ in 🇺🇸
⚡️Cardiac disease is highly prevalent among ESRD pts.
⚡️50% of all ESRD deaths are due to
a CV-related cause👇🏽
💥What causes cardiac disease in ESRD patients?
⚡️Many factors contribute to it - as shown below👇🏽
⚡️In this tweetorial, the focus will be on how the AVF affects the heart
Read 20 tweets
💥 Dialysis Access Associated Venous Thoracic Outlet Syndrome (VTOS) is a rare but under-recognized cause of central vein stenosis in dialysis patients
⚡️Tweetorial on Dialysis Access Associated VTOS 👇🏽
💥Venous Thoracic Outlet Syndrome
is due to:
⚡️Subclavian Vein stenosis caused by
it’s compression in the thoracic
⚡️Thoracic outlet is formed by the 1st
Rib, Clavicle & Subclavius
💥 Subclavian vein stenosis due to thoracic outlet compression can occur in healthy individuals & can present with:
⚡️Intermittent positional venous obstruction (McCleery Syndrome)
⚡️Venous thrombosis (Paget-Schroetter Syndrome)
Read 10 tweets
💥Teaching point re: Rx of dialysis catheter related bacteremia
⚡️IV antibiotic alone is NEVER the correct Rx choice
Rx options are:
☄️IV antibiotic + CVC antibiotic
lock solution
☄️IV antibiotic + CVC exchange
💥The reason IV antibiotic alone is not the correct choice is because it does not eradicate the bacteria in the CVC lumen biofilm
⚡️For effective clearance of bacteria from the biofilm you have to use CVC antibiotic lock solution or exchange the CVC
💥The choice of antibiotic for catheter related bacteremia is listed below👇🏽
⚡️How to prepare the CVC antibiotic lock solution?👇🏽
Read 4 tweets
💥’Physical Examination of the Dialysis Vascular Access’ - Tweetorial

Let’s first review the:
⚡️Anatomy of the Vascular Access
⚡️Vascular Access-related

💥 A dialysis vascular access is a ‘circuit’ and NOT just a ‘connection’ between an artery & a vein

⚡️The circuit consists of:
☄️ Pump (heart)
☄️ Inflow (artery)
☄️ Conduit (body of the access)
☄️ Outflow (vein)
💥 There are 3 basic types of vascular access:
⚡️AVF (arterio-venous fistula)
⚡️AVG (arterio-venous graft)
⚡️CVC (central venous catheter)

☄️AVF: created by a direct connection b/w an artery & a vein
☄️AVG: graft is interposed b/w an artery & a vein👇🏽
Read 19 tweets
💥Tweetorial on ‘Are AVF’s the best dialysis vascular access?
⚡️Do AVFs have better long term patency than AVGs?
⚡️Impact of vascular access type on clinical outcomes?
⚡️Are AVFs cost effective in all pts?
💥Do AVF’s have better long term patency than AVGs?
⚡️Observational studies have shown that AVFs have better cumulative access survival than AVGs but...👇🏽
💥Why is it important to look at the cumulative AV access survival from the ‘Time of AV access creation’ and NOT from the ‘Time of successful AV access use’?
⚡️Let’s take a look at this study which compared the cumulative survival of AVF vs. AVG 👇🏽
Read 18 tweets

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