Arterio-Venous Graft (AVG)

*Arterio - Venous Graft*

- It is an artificial blood vessel used to link an artery and vein.

- It should not be the first priority for permanent access.

The graft is of 3 types:

1. *Straight graft* -

It is radio-basilic placed in forearm.

2. *Looped graft* -

It is brachio-basilic graft placed on forearm, upper arm or thigh.

3. *Curved graft* -

It is brachio-basilic or brachio-axillary graft.

And it is mostly commonly used nowadays.

= *HeRO graft*:

HeRO - Hemodialysis reliable Outflow

- It can be used for patient whose only choice was a catheter, due to venous stenosis or blockages.

“Graft materials”

The graft is made up of biologic and synthetic materials.

i) Biologic material :

• It includes human and animal material. It is rare.

• It may have high risk of infection.

• The artery or vein taking from animals like cow, sheep etc.

  or from the patient's leg itself or from the umbilical

  cord of newborns, etc...

ii) Synthetic material:

• It is used for nearly all graft nowadays.

• The material is polytetrafluoroethylene.

“Making the Graft”

• It is made with surgery that puts a bridge from artery to vein.

• The graft is attached to one vessel, passed through tunnel and attached to one vessel.

• A new graft should be placed at least 3-6 weeks before use.

• It will be healed 2 weeks after placement.

*Complications of Graft*

- Infection

- Stenosis

- Thrombosis

- Steal syndrome

*Pros of Graft*

- It matures immediately before first cannulation.

- It may have more cannulation space than fistula.

- Easier to cannulate.

*Cons of Graft*

- Infection and thrombosis due to synthetic material.

- Graft may develop stenosis.

*Assessing Maturity of AVF & AVG*

The assessing is done by:

1. *Look for*: Check visually without touching for

    - Signs of infection like redness, drainage.

    - Signs of wound healing.

2. *Feel for*: By touching

    - _Thrill_: feel like constant vibration.

    - _Growth in vessel_: Start to grow after surgery and it should be clear within 2 weeks.

    - _Firmness of vessel_: The vessel walls are getting strong.

3.*Listen for*:

      -a bruit oozing sound by auscultation.

 INFECTION CONTROL

- The technician should start with hand washing and change the gloves before touching patient & equipment.

- Both technician and patient wear mask to cover the mouth & nose to prevent the infection.

- Use aseptic technique.

- Provide proper information to the patient about the protection of vascular access.

- Cover the site with large elastic bandage.

 CONCLUSION

Vascular access is one of the most important and challenging part of HD. The dialysis technician have the vital role in caring the patients access. It’s their job to learn how to cannulate fistulas & grafts and to observe access sites for problems. Each patient’s vascular access is a life line and must be treated with great degree of respect and care.