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Access Options Assess the brachial artery for arterial access, which is the only artery that should be used for dual catheter system endoAVF creation. 14 At this point, the brachial artery would have already been assessed for the appropriate diameter of ≥2 mm in diameter so that it can accommodate the endoAVF (dual catheter system) devic e and provide sufficient blood flow. There are multiple venous access options. Note the size of the brachial veins just above the elbow and assess as a potential access point. Also, measure the radial and ulnar veins within 3 inches from the wrist — the upper arm brachial or ulnar or radial must be ≥2 mm in diameter to accommodate procedural components of the dual catheter system (Figure 15) and document findings (Table 6). The physician will decide which option is best for access and if they are a candidate for dual catheter system endoAVF procedure. 14

Figure 15 – EndoAVF (Dual Catheter System) Creation Site Measurements

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Table 6 – Radial and Ulnar Measurements

Source: BD, Bard. WavelinQ™ 4F Vessel Mapping Sheet. BD-12525v2. https://wavelinq.bd.com/wordpress/wp-content/uploads/2020/03/BD-12525v2-WavelinQ-4F- Vessel-Mapping-Sheet.pdf. Accessed October 10, 2021.

Documentation Complete documentation is crucial and there should be a permanent record of the ultrasound examination, interpretation, and images of appropriate anatomy (normal and abnormal). 12 Any variations from normal size anatomy observed should be accompanied by measurements. Images should be labeled with the patient and facility identification, examination date and location of the anatomy imaged. An official interpretation in the form of a final report should be included in the patient’s medical record and retained according to legal, federal , and facility requirements. 12 Post Maturation Protocol Recommendations After the endoAVF (dual catheter system) procedure is completed, the patient post-procedure follow-up appointment occurs between 2-6 weeks per standard of care protocols. 14 Vessel mapping protocols post-fistula creation include measuring the brachial artery flow rate which should be ≥ 500 ml/min, determining which superficial outfl ow vein is dominant (cephalic or basilic) and that it measures at least 4 mm in diameter. 16 A brachial artery flowrate of ≥ to 500 ml/min and a superficial outflow vein of at least 4 mm in diameter is considered matured sufficiently to begin hemodialysis. 16