RT Journal
A1 Chinitz J, Onesti G, Brest AN, Swartz C
T1 RAdiography of the av shunt in hemodialysis
JF JAMA
JO JAMA
YR 1969
FD March 24
VO 207
IS 12
SP 2286
OP 2286
DO 10.1001/jama.1969.03150250116032
UL http://dx.doi.org/10.1001/jama.1969.03150250116032
AB To the Editor:— 
    Cannula failure continues to be a most vexing problem in maintenance dialysis. While this has prompted a trend toward the use of internal arteriovenous fistulae1,2 it has also stimulated efforts toward improvement in shunt design.3,4 To determine causes for progressive decrease in shunt flow or recurrent episodes of cannula clotting we have performed shunt contrast arteriography and venography in straight shunts with standard x-ray contrast media, methylglucamine diatrozoate-60%. Venous injection was well tolerated but rapid manual arterial injection was associated with excruciating burning pain of such a disagreeable nature that patients either outrightly refused repeat study or pleaded for general anesthesia. Five percent sodium chloride and 20% mannitol solutions gave identical pain on arterial injection. To minimize discomfort we diluted the contrast material with sterile distilled water in a three to one ratio, resulting in a 15% solution of methylglucamine diatrozoate with an osmolarity of