SOME DEFINITIONS BEFORE TALKING ABOUT STEPS FOR MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS
MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS Procedures | Responsible Person/s |
Explain to the patient and family members the need for vascular surgery to create AVF or AVG; or a hemodialysis central venous catheter for hemodialysis treatment. | Nephrologist |
Complete a written order for creation of AVF or AVG or insertion of a temporary or permanent central venous catheter. | Nephrologist |
Contact the Vascular Surgeon and writes a consultation for vascular surgery intervention. | Nephrologist |
In the event of malfunction of AV access or clotted AVF, AVG or central venous catheters; the Nephrologist shall assess the patient and contact the Vascular Surgeon. | Nephrologist
Vascular Surgeon |
Insert temporary central venous catheter for hemodialysis in the ICU. In special cases, the nephrologist may insert the central venous catheter in the Dialysis Unit. | Nephrologist |
Insert the hemodialysis permanent central venous catheter (Permcath) in the Cardiac Catheterization Laboratory (CCL) or Operating Room | Vascular Surgeon |
Use aseptic technique to access; perform exit-site care and manipulation of the hemodialysis central venous catheter. | Dialysis Registered
Nurse |
Perform catheter care pre or post-hemodialysis treatment on the day of dialysis in the unit. | Dialysis Registered
Nurse |
For permanent AV access:
1. Blood pressure or venipunctures are not performed on the AV access limb. 2. Circular occlusive dressings are not applied on the AV access limb at all times. 3. Patient is instructed not to wear restrictive clothing that impedes blood flow to the AV access limb
|
Dialysis Registered
Nurse |
Give teaching to the patient to care of his/her AVF, AVG, or central venous catheter as follows:
1. Assess the level of the patient’s knowledge of their hemodialysis access, which includes purpose, description, care, assessment and emergency care. Provide instruction as required, utilizing expertise and knowledge from all members of the renal multidisciplinary team. 2. Teach the patient the importance of good hygiene. 3. Instruct the patient/family member in the care of vascular access and to recognize the signs and symptoms of infection.
|
Dialysis Registered
Nurse |
Refer to Patient Teaching Policy about Central Venous Catheter care and Care of AV Graft and AV Fistula. | Dialysis Registered
Nurse |
Advice the patient to contact the hospital immediately if he/she encounters problems with vascular access. The patient is given an emergency telephone number to contact the hemodialysis unit or the patient can go to the nearest hospital, emergency services. | Dialysis Registered
Nurse Nephrologist |
Documents assessment, management and patient education of vascular access clearly and legibly on the Focus Charting Sheet. | Dialysis Registered
Nurse Nephrologist |
Advice the patient to contact the hospital immediately if he/she encounters problems with vascular access. The patient is given an emergency telephone number to contact the hemodialysis unit or the patient can go to the nearest hospital, emergency services. | Dialysis Registered
Nurse Nephrologist |
REFERENCE FOR MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS