Patient Name:     ,           

DOB:        SEX:    

Ordering Physician:     ,    

Procedure:      upper extremity AV fistulogram  

Indication:  Decreased function dialysis.     

Date:      

Operators:   John Doe, MD (Attending)/Jane Doe, MD (Fellow)     

Medications:    

Fluoro time:     

Contrast:      cc s  nonionic  

Access site:     

Complications:  None  immediate

 

The risks, benefits, and alternatives to the procedure and sedation were explained.  The specific risk of fistula occlusion was detailed and accepted. Written informed consent was obtained.  

The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure.

The _______AV fistula and overlying soft tissues were prepped and draped in sterile fashion. Ultrasonographic evaluation of the fistula and outflow  was performed and an appropriate puncture site chosen.  Images were transferred PACS. Under ultrasound guidance, the outflow vein was punctured antegrade with a 21 gauge needle. Needle entry was documented and an image stored.  A 0.018″ wire was passed centrally and the needle exchanged for a     F transitional dilator.

Diagnostic fistulography was performed from the access point to the right atrium using nonionic contrast.

Findings:

Impression:

Normal AV Fistulagram