Chapter 6: Physical Examination (PE)

Physical examination (PE) is basic to all fields of medicine. Unfortunately, in many instances, it has been replaced by more elaborate and costly technical approaches to diagnosis. In the evaluation of the hemodialysis access, PE remains indispensable in diagnosing problems and making decisions concerning management. PE is easily learned and performed, inexpensive to apply, and provides instant information with a high level of accuracy, especially in the cases of the native vein fistulas (AVF). To the physician dealing with dialysis access, PE is a mandatory skill.

As a lifelong access utilization strategy, peritoneal dialysis should be considered as the first dialysis modality in suitable cases, followed by appropriately planned hemodialysis. Duplex Doppler Ultrasonography Examination (DDU) is the logical step following history and PE for pre-operative vascular mapping in determining the optimal hemodialysis access type and site. DDU will also assess and diagnose many vascular access problems and direct the proper surgical or endovascular decision for appropriate management. Most of the discussion of PE is based on AVF as it is more sensitive PE than arteriovenous graft (AVG). Most principles discussed are applicable to both. This chapter also has an extensive link to the use of Ultrasound in dialysis access.

Chapter content coming soon.