Page 390 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 375

Veins Radial artery
(blood to (blood from
the heart) the heart)
AV fistula

to dialyzer

from dialyzer

FIGURE 8–4 • AV Fistula and graft.

Once the treatment is finished, the needles are removed, pressure is applied until
hemostasis has been achieved, and a dry, sterile dressing is placed over the site.
Checking the patient for complications at internal access sites is critical to
maintain the patient’s lifeline for HD. Complications include thrombosis, infec-
tion, ischemia, and hemorrhage. Nursing care includes:
Auscultating a bruit and palpating a thrill to determine site patency. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Checking the site for infection indicated by erythema, edema, and exudate.
Monitoring the patient’s temperature for signs of infection.
Maintaining a clean, dry dressing to prevent infection.
Monitoring for changes in vascular status (temperature, sensation, color, and
capillary refill). Steal syndrome can occur where arterial ischemia is noted at
the affected extremity. Notify the surgeon if this occurs.
Monitoring the patient for hypotension, which can lead to site clotting.
Elevating the extremity to prevent edema.
Communicating to all health care members that no BPs, blood work, or IVs
should be performed near the access sites, which can clot the site; usually
this information is included on a special bracelet that the patient wears on
the extremity or noting this at the patient’s bedside.
Notifying the physician if clotting is suspected and if there is bleeding at the
insertion site.
Teaching the patient and significant others how to check for graft patency
and to speak up if someone tries to perform BPs, venipunctures, or laboratory
work on that extremity. The most common reason for admission to the hos-
pital for HD patients is clotting of the internal access site. Preservation of this
graft is a high priority for the patient and nursing staff.