Name of the Procedure:

Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study Common name: Duplex ultrasound for hemodialysis access planning

Summary

A duplex ultrasound is a non-invasive imaging test used to evaluate the blood flow in arteries and veins. For patients needing hemodialysis access, this procedure helps assess the quality of the blood vessels in both arms to ensure safe and effective dialysis treatment.

Purpose

This procedure addresses the need to evaluate blood vessel suitability before creating hemodialysis access. The goals are to:

• Identify optimal vessels for creating a vascular access.
• Ensure adequate blood flow for hemodialysis.
• Minimize the risk of complications during and after access creation.

Indications

• Chronic kidney disease requiring hemodialysis.
• Evaluation of veins and arteries for vascular access planning.
• Symptoms such as swelling, pain, or prior unsuccessful attempts at hemodialysis access.

Preparation

• No specific fasting is required.
• Continue taking all prescribed medications unless instructed otherwise.
• Wear loose clothing to allow easy access to the arms and neck.
• Previous imaging or medical records may be reviewed.

Procedure Description

1. The patient lies on an examination table, usually with the arms extended.
2. A clear gel is applied to the skin over the blood vessels.
3. A handheld device called a transducer is used to send and receive sound waves.
4. The transducer is moved over the skin to capture images of the arteries and veins.
5. The technician takes multiple images and measurements to assess blood flow and vessel diameter.
6. Both arms are scanned to identify the best site for hemodialysis access.

Duration

The procedure typically takes about 45-60 minutes.

Setting

Performed in a vascular lab, hospital, or outpatient clinic with ultrasound facilities.

Personnel

• Vascular technologist or ultrasound technician to perform the scan.
• Radiologist or vascular surgeon to interpret the results.

Risks and Complications

• Minimal risks since it is a non-invasive procedure.
• Rare possibility of skin irritation from the gel.
• No radiation or sedation involved.

Benefits

• Identifies the best vessels for hemodialysis access.
• Non-invasive with no side effects, providing immediate insights.
• Helps plan a more successful and efficient hemodialysis access surgery.

Recovery

• No specific recovery time needed; patients can usually resume normal activities immediately.
• Follow any specific instructions provided by the healthcare provider.

Alternatives

• Magnetic Resonance Angiography (MRA) or CT Angiography, which provide detailed images but involve contrast material and radiation.
• Physical examination alone, though less accurate.

Pros and Cons:

• MRA/CT: More detailed but involve radiation and contrast agents.
• Physical exam: Quick but not as detailed or accurate.

Patient Experience

• The patient might feel slight pressure from the transducer but generally experiences no pain.
• The gel may be cold but is harmless and easily wiped off after the procedure.
• No downtime or discomfort following the procedure, making it convenient and patient-friendly.

By following this guide, patients can better understand what to expect during a duplex ultrasound for hemodialysis access planning.