Arteriovenous (AV) graft and/or fistula precautions

ARTERIOVENOUS (AV) GRAFT AND/OR FISTULA PRECAUTIONS

DEFINITION

  1. Arteriovenous (AV) Fistula – is the surgical creation of an internal vascular connection, created by joining a vein directly to an artery.
  2. Arteriovenous (AV) Graft – is the surgical creation of an internal vascular connection, created by interposing a fabric or Teflon tubular graft between a vein and an artery.
  3. Thrill – is the vibrating sensation created by pressurized arterial blood striking the walls and valves of veins as it circulates through the graft or fistula.
  4. Bruit – is the swishing turbulence sound heard by using a stethoscope or Doppler, created as blood flows from an artery to a vein inside a graft or fistula.

Warning
It’s important to define the standards for the care of patients with AV grafts and fistulas in order to minimize clotting, trauma, and infection.

Make sure that:

No veni-punctures on the extremity designated for access creation.
Put an AV Graft/Fistula Precautions sign at the bedside when the patient is identified for access creation. Ensure that patients ID band is not on the extremity to be used for access creation. Teach the patient and family how to care for the graft or fistula.

Make sure that:

Palpate the AV graft and/or fistula vascular access for a thrill and auscultate for a bruit every eight hours and document ongoing assessment.

Make sure that:

If patient is for surgery, ensure that the patient is positioned for his/her operative procedure in such a manner to avoid putting undue pressure or obstruction to the access extremity.

Post-operatively:

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Observe the access site closely for bleeding and bruising, inspect for approximation of suture line. Auscultate for bruit, and palpate for thrill over access site every hour post access creation for 4 hours, then every 4 hours for 12 hours and then every 8 hours thereafter.

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Notify physician if no bruit or thrill are present, bleeding occurs, or if suture line edges are not closed.

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Ensure that dressing and clothing are loose over the access site.

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Stop any bleeding with only direct, localized pressure. Do not use wrap-around elastic bandages over access extremity.

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Absolutely no veni-punctures or blood pressure measurements should be performed on access extremity.

Post Hemodialysis Treatment (for Ward and ICU Nurses):

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Observe access site closely for signs of unusual swelling, bruising, heat, redness or pain.

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Palpate for thrill and auscultate for bruit over access site upon receiving patient to the ward and then every 8 hours. Notify physician immediately if no thrill or bruit is present.

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Observe access site closely for bleeding.

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Notify physician immediately if bleeding is observed. Use only direct localized pressure over bleeding access site. Does not use wrap-around elastic pressure dressing.

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Remove band-aids, plasters, from needle sites six hours after hemodialysis treatment, or the next morning.

About the Author

Pharmacist interested in improving the health outcome for every single case he meets.

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