| Inspection |
Assesses the wound and its correct healing of the AVF anastomosis. Inspect the body of the AVF to determine if it is visible and, if so, for what length (optimal length> 6 cm). Evaluate the apparent diameter and depth to determine if it has the potential to be cannulated. Assess whether accessory veins are visible. |
| Palpation |
Normally, the thrill of the AVF anastomosis is perceptible to the touch as a vibration. The body of the AVF should be soft and easily compressible. If the thrill is not perceived, the AVF can be thrombosed. The thrill should disappear when the outflow vein is occluded manually more proximally due to the cessation of flow. If the thrill does not go away, an accessory vein is present distal to the occlusion point. When AVF is completely occluded manually, the arterial pulse distal to the AVF anastomosis must be increased. The degree of increase is directly proportional to the flow of the AVF. If AVF is hyperpulsive (an indication of outflow stenosis), the change in pulse produced by manual occlusion reflects the severity of the stenosis that is causing hyperpulsatility. To evaluate a possible iuxta-anastomotic stenosis it is useful to palpate the vein and artery distal to the anastomosis with the finger. In case of stenosis, the impulse disappears abruptly when the site of iuxta-anastomotic stenosis is encountered. Downstream the impulse will be weak or undetectable |
| Auscultation |
Auscultation of the bruit is useful for determining the character of the diastolic component of the flow. Normal finding is the low rumbling tone with a prominent diastolic component. In case of stenosis there is a progressive increase in resistance which makes the diastolic component disappear and the bruit becomes more acute. |
