Dialysis Access Creation Operative Note (AV Fistula/AV Graft)

Date/Time: [Date and time; start–stop if available]

Facility/Location: [Facility and operative suite/location]

Preoperative Diagnosis: [Indication for hemodialysis access; relevant access history (e.g., prior failed AVF/AVG, catheter dependence, central venous issues)]

Postoperative Diagnosis: [Typically same as preoperative; add operative discoveries if any]

Procedure Performed: [Laterality and anatomic configuration; e.g., "Left radiocephalic AV fistula creation, end vein to side artery" or "Right upper arm loop PTFE AV graft placement"]

Surgeon: [Primary surgeon]

Assistant(s): [Assistant(s) if any]

Anesthesia: [Type; regional block details if applicable]

Perioperative Details

• Antibiotic prophylaxis: [Agent, dose, timing] (Omit if not given.)
• Intraoperative anticoagulation: [Heparin dose and timing] (Omit if not given.)
• Estimated blood loss: [mL]
• Implants: [Graft material, diameter, configuration; lot/serial referenced per implant log] (Include only for AVG.)
• Complications: [Intraoperative complications and management] (Omit if none occurred.)

Indications

[Brief narrative of indication] (3–5 sentences. Include: current need for access [planned HD initiation / catheter dependence / failing prior access]; rationale for chosen access type and site [AVF vs AVG; anatomic level]; confirmation of informed consent; if high-risk features present, note key risks discussed [steal syndrome, non-maturation, thrombosis]. If no formal preoperative mapping was performed, state that vessel selection was based on physical examination and intraoperative assessment.)

Preoperative Vessel Assessment

(Include this section only if formal duplex mapping or venography informed planning. Omit entire section if no formal mapping was performed.)

• Modality/date: [Duplex ultrasound / venography; date]
• Target artery: [Diameter if available; calcification/quality; anatomic level]
• Candidate veins: [Diameter with tourniquet; compressibility; depth; continuity; any concerns]
• Access selected based on mapping: [Configuration and site chosen with rationale]

Procedure Details

Setup: [Patient positioning; limb preparation; skin prep and drape; timeout confirmation; anesthesia and monitoring; incision location and length]

Dissection and vessel preparation: [Identification and mobilization of target vein including length; identification of target artery and method of control]

AVF-specific steps: [Branch ligation; vein dilation method; valve management if relevant] (Include only for AVF.)

AVG-specific steps: [Subcutaneous tunnel creation: route and depth plane; graft passage and orientation] (Include only for AVG.)

Anastomosis creation:

• For AVF: [Configuration: end-to-side / side-to-side / end-to-end]; [Arteriotomy/venotomy technique]; [Suture material and technique (e.g., running 7-0 polypropylene)]; [Flush sequence before clamp removal]
• For AVG: Arterial anastomosis: [Configuration; suture details] | Venous anastomosis: [Configuration; suture details]; [Graft orientation verification]

(Include only the anastomosis type corresponding to the procedure performed.)

Flow restoration and hemostasis: [Clamp release sequence; immediate hemostasis measures; assessment for bleeding at anastomoses]

Intraoperative findings/decisions: [Vessel quality issues; unexpected anatomy; change in plan or conversion and rationale; impact on prognosis] (Include only if findings affected decisions or outcomes.)

Completion Assessment

(This section is mandatory and must not be omitted.)

• Access patency: Thrill at anastomosis [present / absent]; Bruit [present / absent / not assessed]
• Distal perfusion: Radial pulse [intact / diminished / doppler-only / absent]; Ulnar pulse [intact / diminished / doppler-only / absent]; Capillary refill [normal / delayed]; Hand warmth [warm / cool]; Motor [intact / limited (specify)]; Sensory [intact / limited (specify)]
• Neurologic assessment limitations: [Regional anesthesia limited exam] (Include only if applicable.)
• Abnormal findings and interventions: [Intervention performed and final status] (Include only if abnormality identified.)

Closure

[Hemostasis confirmed; closure technique by layer with materials; skin closure method; dressing type applied]

Disposition

Condition: [Stable / specify concerns]

Destination: [PACU / inpatient unit / discharge home]

Postoperative Plan

• Wound care: [Dressing instructions; keep clean/dry; when to change]
• Access protection: No venipuncture or BP cuffs on access arm; patient to check daily for thrill and report if absent
• Pain management: [Analgesic regimen; escalation guidance]
• Follow-up: Wound/complication check at ~2 weeks; maturation evaluation at ~4–6 weeks for AVF; duplex ultrasound if maturation inadequate on exam
• Cannulation timing: [AVF: Await clinical maturation and clearance prior to cannulation] [AVG: Expected cannulation timing based on graft type (standard vs early-cannulation)] (Include only the path corresponding to the procedure performed.)
• Catheter plan: [If tunneled catheter present, continue until access usable; criteria/workflow for removal] (Omit if no catheter.)
• Antithrombotic therapy: [Agent, dose, duration, and indication] (Omit if not prescribed.)