Vascular Access

Vascular Access

1. temporary

   • indication
     • place at bedside
     • use while waiting for permanent site to mature
     • when need immediate dialysis
   • multi lumin CVL in large vein
   • can be left 1-3 weeks
   • RN responsibilities
     • clean dressin
     • monistor s/s infection
     • keep clamped

2. Arteriovenous Fistulas

   • st choice for chronic dialysis pt
   • longer lift span than AV graft
   • surgical procedure
     • need 3 mo to mature
     • commonly created in forearm
     • anastomosis of artery and vein
       • better patency and fewer complications
       • sometimes more difficult to create
   • if don't feel thrill/bruit
     • HCP may need to sx de-clot/restore patency

3. Arteriovenous Grafts

   • synthetic material/bridge b/w artery & vein
   • 2nd choice for internal access
   • place when vessels not good for fistula
     • too deep
     • too tortuous
     • too weak

4. Nursing Care

   • Assessment
     • ask
       • bleeding
       • swelling
       • bruising
       • redness
       • drainage
       • pain
       • change in thrill
     • skin integrity
     • pain/numbness
   • Education
     • no restrictive clothing/jewlry
     • no heavy lifting on side
     • no venipuncture/bp on access arm
     • assess access site daily