EBPG HD New - Vascular Access Part II

Which of the following problems is NOT an indication for stenosis treatment in a patient with an autogenous AV fistula?

	Diameter reduced by 60 % without a reduction in access flow and dialysis dose.
	Difficulties in cannulation
	Prolonged bleeding time after cannulation and removal of the cannulae
	Ischemia of the hand due to arterial inflow stenosis
	Diameter reduced by > 50 % with a reduction in access flow and dialysis dose.

Which of the following statements concerning central venous obstruction is TRUE?

	Central veins can be examined by Doppler sonography.
	Previous central venous catheters prevent central venous obstruction.
	The majority of patients with central venous obstruction suffer from goitre.
	About 40% of patients with previous subclavian vein catheters and 10 % of patients with jugular vein catheters develop central venous obstruction.
	About 10% of patients with previous subclavian vein catheters and 40 % of patients with jugular vein catheters develop central venous obstruction.

A 71 year old patient with diabetic nephropathy develops ischemic pain at rest after creation of an arterio-venous fistula. Which of the following diagnostic procedures is NOT useful?

	Measurement of digital pulses and calculation of the digital-to brachial-index.
	Transcutaneous oxygen determination.
	Rating of pain disappearance according to World Health Organization's 3-step analgesic ladder.
	Doppler sonography of the forearm arteries.
	Physical examination.

Please rate the preferred dialysis access for patients with chronic kidney disease stage 5 in a descending order, beginning with the favourite access first. A Non-tunnelled catheter in the right jugular vein, B native AV-fistula; C tunnelled catheter in the right jugular vein, D tunnelled catheter in the left jugular vein.

	A - B - C - D
	A - C- D - B
	B - C - D - A
	B - A - C - D
	A - B - D - C

Which of the following agents has been shown to prolong increase patency-rates of tunnelled haemodialysis catheters?

	Vancomycin
	Low dose Warfarin
	Acetyl salicylic acid
	Acetyl salicylic acid in combination with clopidrogel
	Heparin

A patient with acute renal failure is treated by hemodialysis using a un-tunnelled central venous access. Minutes before starting the next dialysis session, the blood cultures of the febrile patient, are tested positive Gram positive cocci. What do you do?

	Initiate prompt appropriate antibiotic treatment for a suspected catheter infection, leaving the catheter in place.
	Remove the catheter immediately and start appropriate antibiotic treatment.
	Start dialysis and initiate antibiotic treatment after the dialysis session, as most antibiotics are removed by dialysis.
	Initiate prompt appropriate antibiotic treatment for a suspected catheter infection, leaving the catheter in place if the C-reactive protein (CRP) decreases by >50 % within the first 24 hours of treatment.
	Initiate prompt appropriate antibiotic and remove the catheter if blood flow rates fall below 150 ml/min.