VAMP © Vascular Access Monitoring &
Surveillance Flow Chart
Submitted by: Lawrence Spergel, MD, FACS
Dialysis Management Medical Group
San Francisco, CA USA
This educational item was produced through the AV Fistula First Breakthrough Initiative Coalition, sponsored by the Centers for Medicare and Medicaid
Services (CMS), Department of Health and Human Services (DHHS). The content of this publication does not necessarily reflect the views or policies of the
DHHS, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author(s) assume full
responsibility for the accuracy and completeness of the ideas presented, and welcome any comments and experiences with this product.
VAMP © Vascular Access Monitoring & Surveillance Flow Chart
Functioning Access
Physical
Assessment
q Treatment
Kt/V (URR)
q 1 month
Normal
Recirculation Study
pm for suspected
problem
Changes Observed
>10% decrease
after r/o other
causes
Dynamic VP @ QB
200 q Tx 9
(or static VP@
Qb 0 q 2 wks)
Normal
<10% (by BUN)
<5% (by Transonic)
No Change
Abnormal
Arm
Swelling/Clots/
Prolonged
bleeding/loss
of continuous
bruit/other
Non-Functioning Access
Vascular Access
Abnormal
>10% (by BUN)
>5% (by Transonic)
Normal
<125 mm
dynamic
Or<=0.5 static
Abnormal
>125 mm x 3 (or 0.5
ratio x 2 for static)
*see 1. footnote below
(Occluded/Thrombosed)
AP
q Treatment
Normal
Abnormal
Trend of
>negative AP
or >-260 or
unable to
achieve Rx
Qb First r/o
needle
g/other
Fistulogram (or doppler US)
Normal
Nephrologist to reevaluate indicators of
dysfunction
Abnormal
(Preferred referral path, but if 1PTA in prior
Access Blood Flow (ml/min) q.
month & post-intervention
Successful
Abnormal
AVG: <600 or
20% in 1
month
*see 2.footnote
below
Normal:
AVG: =>600
AVF:=>RxQ
b
Abnormal >2000
AVF:<RxQb
Evaluate for “steal” - hand
ischemia/high output cardiac
failure
Thrombolysis / Thrombectomy
in Radiology (or directly to
Surgery)
45 days or 2 in 6 mos. or new access – obtain
surgical consult)
Unsuccessful
Technical failure
Interventional Radiologist
(PTA/Thrombolysis/Stent)
Surgeon
(Revision/New
Access)
Presumptive Success
Normal
Re-assess Surveillance Indicators per
Protocol at next dialysis sessions
Surgery
Abnormal
1. For static pressures, see attached protocol for measuring both venous and arterial intra-access pressure ratios.
2. If AVG access blood flow falls by 20% in 1 month, and flow is below 1000, repeat next session and if still lower by 20%, refer for fistulogram.
L. Spergel
VAMP ©