SCREENING FOR DIALYSIS ACCESS GRAFT MALFUNCTION - COMPARISON OF PHYSICAL-EXAMINATION WITH US

PURPOSE: To test the reliability and performance of two physical diagn osis algorithms for use in physical examination of vascular access gra fts. MATERIALS AND METHODS: Grafts were assessed in 39 patients by mea ns of physical examination performed by four observers. Grafts were ch aracterized as having a thrill, pulse, or indeterminate examination at three locations (arterial, midpoint, venous). Findings with this algo rithm were compared with those from ultrasound (US) with volume flow m easurements. RESULTS: Patients with a thrill at all three locations of the graft all had volume flows greater than 450 mL/min (negative pred ictive value = 100%). Of patients with a pulse at any of the three loc ations, only 28% (positive predictive value) had a volume flow of 450 mL/min or less. CONCLUSION: Physical examination is a good screening t est for ruling out the low flows associated with impending access graf t failure, thereby eliminating the need for routine US for many patien ts.