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We use a  protocol from VTS in Norfolk, VA that goes like this:

Obtain brachial BP from the arm contralateral to the side with the AVF / AVG

From the arm with the functioning AVF / AVG:
Record PPG waveform from the third digit and the digit pressure; calculate DBI

Compress the AVF / AVG (routine for a Technologist to do this) and:
Record PPG waveform from the third digit and the digit pressure;  calculate DBI

There is evidence for significant steal if the waveform amplitude increases significantly (doubles) and the DBI increases by > .20 when the AVF / AVG is compressed (closed)

DBI of .60 has been shown prospectively to be linked to patients at risk for symptomatic steal.   The patient can have a relatively low DBI that does not improve much when the access is compressed due to arterial occlusive disease rather than from the steal into the AV access.

You can also find protocols that use duplex to evaluate the significance of suspected steal.

Tish Poe

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Ramona McNeice
Sent: Monday, May 18, 2009 5:25 PM
To: [log in to unmask]
Subject: Re: AVF Steal Protocols

I think the doctor compresses the graft.


--- On Mon, 5/18/09, Rita Zeak <[log in to unmask]> wrote:

From: Rita Zeak <[log in to unmask]>
Subject: Re: AVF Steal Protocols
To: [log in to unmask]
Date: Monday, May 18, 2009, 3:02 PM
Erica, I think you compress the graft. Anybody ?


-----Original Message-----
From: Erica Moreland <[log in to unmask]>
To: [log in to unmask]
Sent: Fri, 15 May 2009 11:09 pm
Subject: AVF Steal Protocols

Anyone out there do AV Fistula steal studies? Wondering if anyone was willing

to share their protocols?

Thanks

Erica RVT



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