Posters
Academic Level (Author 1)
Faculty
Discipline/Specialty (Author 1)
Surgery
Discipline Track
Clinical Science
Abstract
Background: Non-invasive ultrasound evaluation is part of the preoperative evaluation of patients needing creation of arteriovenous access. This study requires patients to return for an additional visit for imaging or visit an outpatient imaging facility. These visits produce delays in surgery and increase costs in healthcare. Point of care ultrasound examination at the same time of initial physician visit, allows to decrease cost, improvement of anatomical planning, and decrease timing of surgery.
Methods: We reviewed the UTRGV Vascular Surgery Database from January to December 2020, for patients who has elective outpatient arteriovenous access creation, in which has pre-operative evaluation with rapid ultrasound evaluation performed by surgeon at office visit. The evaluations were performed in the non-dominant extremity, the superficial veins and arteries. If no suitable vessels were identified for arteriovenous access in the non-dominant vessel, examination of the contralateral dominant extremity was performed. Patients with suspicious central stenosis, morbid obesity, were excluded for the performance of POCUS examination. After office visit patients were schedule for surgery. Data was obtained for demographics, type of surgery, successful creation of arteriovenous access, maturation and successful use for dialysis.
Results: Fifteen patients underwent POCUS examination at vascular surgery visit and underwent creation of arteriovenous access, 9 males and 7 females, average age of 51.1 years. All patients have creation of arteriovenous fistulas, 7 brachiocephalic, 4 radiocephalic and 4 brachiobasilic who were plan for creation in two stages. An AV fistula was successfully performed in 14 out 15 patients (93.3%) with presence of thrill and bruit at outpatient visit follow-up. Four of the 15 AV fistulas successfully mature and were able to establish as a successful access for dialysis; 5 additional patients have been clear to be use for dialysis, with 60% of all access being currently use in dialysis or clear to use for dialysis. No patient developed steal or infection. The total savings calculated for performance of POCUS examination was 9,480 dollars as unilateral testing is nation average of 632 dollars per study.
Conclusions: This preliminary study results demonstrates that performance of POCUS examination by surgeon in office, is a suitable technique which allows for creation arteriovenous access creation, a short period for surgery scheduling performance, and with significant savings in healthcare costs of the patient.
Presentation Type
Poster
Recommended Citation
Mathur, Urvashi and Peralta, Sotero, "Use of Point of Care Ultrasound in the pre-op evaluation of dialysis patients needing creation of permanent arteriovenous access – preliminary study" (2023). Research Colloquium. 7.
https://scholarworks.utrgv.edu/colloquium/presentation/poster/7
Included in
Use of Point of Care Ultrasound in the pre-op evaluation of dialysis patients needing creation of permanent arteriovenous access – preliminary study
Background: Non-invasive ultrasound evaluation is part of the preoperative evaluation of patients needing creation of arteriovenous access. This study requires patients to return for an additional visit for imaging or visit an outpatient imaging facility. These visits produce delays in surgery and increase costs in healthcare. Point of care ultrasound examination at the same time of initial physician visit, allows to decrease cost, improvement of anatomical planning, and decrease timing of surgery.
Methods: We reviewed the UTRGV Vascular Surgery Database from January to December 2020, for patients who has elective outpatient arteriovenous access creation, in which has pre-operative evaluation with rapid ultrasound evaluation performed by surgeon at office visit. The evaluations were performed in the non-dominant extremity, the superficial veins and arteries. If no suitable vessels were identified for arteriovenous access in the non-dominant vessel, examination of the contralateral dominant extremity was performed. Patients with suspicious central stenosis, morbid obesity, were excluded for the performance of POCUS examination. After office visit patients were schedule for surgery. Data was obtained for demographics, type of surgery, successful creation of arteriovenous access, maturation and successful use for dialysis.
Results: Fifteen patients underwent POCUS examination at vascular surgery visit and underwent creation of arteriovenous access, 9 males and 7 females, average age of 51.1 years. All patients have creation of arteriovenous fistulas, 7 brachiocephalic, 4 radiocephalic and 4 brachiobasilic who were plan for creation in two stages. An AV fistula was successfully performed in 14 out 15 patients (93.3%) with presence of thrill and bruit at outpatient visit follow-up. Four of the 15 AV fistulas successfully mature and were able to establish as a successful access for dialysis; 5 additional patients have been clear to be use for dialysis, with 60% of all access being currently use in dialysis or clear to use for dialysis. No patient developed steal or infection. The total savings calculated for performance of POCUS examination was 9,480 dollars as unilateral testing is nation average of 632 dollars per study.
Conclusions: This preliminary study results demonstrates that performance of POCUS examination by surgeon in office, is a suitable technique which allows for creation arteriovenous access creation, a short period for surgery scheduling performance, and with significant savings in healthcare costs of the patient.