NKF K/DOQI GUIDELINES Executive Summaries | Anemia | Hemodialysis | Peritoneal Dialysis | Vascular Access | Nutrition | CKD 2002 | Dyslipidemias | Bone Metabolism | Hypertension and Antihypertensive Agents | Cardiovascular Disease in Dialysis Patients | History of K/DOQI | Pediatric Bone | Anemia 2006 | Updates 2006

Clinical Practice Guidelines and Clinical Practice Recommendations
2006 Updates
Hemodialysis Adequacy
Peritoneal Dialysis Adequacy
Vascular Access

II. CLINICAL PRACTICE RECOMMENDATIONS FOR VASCULAR ACCESS

CLINICAL PRACTICE RECOMMENDATIONS FOR GUIDELINE 5: TREATMENT OF FISTULA COMPLICATIONS

5.1 If a new fistula access has vein margins that are difficult to discern on physical examination and cannulation frequently is associated with aspiration of clot, the patient should be referred for access marking by means of DDU to define the center of the vessel and depth of the fistula. A diagram of these findings should be sent to the dialysis unit.

• 5.1.1 The patient should be taught to examine his or her access daily, while at home, for thrombosis.

RATIONALE
Many patients present with an occluded access. In a fistula, successful declotting decreases with the duration of thrombosis (see CPG 5.4.2). Thrombus may propagate into side branches or become organized, increasing resistance to extraction. Most thromboses occur at home, and when questioned, many patients cannot recall when they last felt for the access thrill or pulse. The Work Group believes that this area is ripe for research on the efficacy of simple teaching on the early detection of thrombosis and the degree of early, as well as late, patency achieved by intervention.