1) Access type:
native / graft / hybrid
2) Site:
left / right forearm / upper arm
3) Clinical problem:
newly created / decreased VF / increased VP / occlusion
4) Age of vascular access:
____ years ____ months
5) Result:
lumen narrowing :
lesion location :
flow turbulence : yes / no
VF from feeding brachial artery : adeqaute / inadeqaute
VF= _____ ml/min
6) Suggestion:
__ clinical follow up
__ may try shunt puncture
__ keep warm packing
__ keep handgripping exercise
__ need recent PTA
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