Do your Vascular surgeons attempt fistulas with no- tourniquet diameters less than 2. 5 mm and just assume a workable vein will be available with intraop tourniquet use?

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-----Original Message-----
From:         Denise Levy <[log in to unmask]>
Sender:       UVM Flownet <[log in to unmask]>
Date:         Sun, 4 Jul 2010 09:52:04 
To: <[log in to unmask]>
Reply-To:     UVM Flownet <[log in to unmask]>
Subject: Re: Torniquet use with fistula mapping.

I personally do not use a tourniquet,, I place the patient flat, raise the
bed height, drop the arm, abduct the arm, and place the patient arm on a
pillow in my lap. Arm hanging downward is best.
I have seen too many tourniquets left on after blood drawing.. they scare
me.. Also the vascular surgeon may apply a tourniquet in the OR himself..
Make the patient comfortable and warm. Cold arms do restrict the veins.
Just my philosophy and if a vein is 1.9 mm or less it is small throughout
and is not going to be big enough to sew anything to. Also once the fistula
is in place the vein will enlarge.
Any others with this technique or protocol?


On Sat, Jul 3, 2010 at 7:12 PM, Joe Swenson <[log in to unmask]> wrote:

> Seeking thoughts, theories and comments regarding the use of torniquets for
> the mapping of first time fistula patients. If resolution capabilities
> allow
> visulization of veins a little less than 1 mm, and torniquets almost
> certainly
> yield 2 mm dilation, and 2.5 mm is the diameter goal-- are tourniquets
> really
> needed since it seems anyone with a detectable vein most likely will meet
> the
> criteria og 2.5 mm? Is torniquet use problematic due to vasospasms?
> Literature suggests pre and post tourniquet numbers get more patients to
> fistulas who may otherwise not meet the 2.5 criteria but data on post
> fistula
> outcomes for torniquet 2.5's are not apparent. What patients are not able
> to
> dilate, at least somwhere along the basilic or cephalic? Also, specific
> torniquet
> protocols for use in venous mappings have escaped my research-- there are
> plenty established for venipunture use but not for extended times that
> occur
> during mappings. Potential patient injuries as a result of extended times
> on
> elastic tourniqets pose some hospital acquired injury risks that have to be
> considered--our PI department insisted I provide policy and procedure
> references before implementing torniquet use and I have yet to locate any
> referenced material on the subject. Comments?
>
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-- 
Denise Levy
Saratoga, CA
Ultrasound Professional Credentials
RDMS, RVT, RDCS
Transcranial Doppler
MISS Group, San Jose, CA
408-391-0837

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