Basic Access Study Guide Flashcards
What are the 2 types of interal vascular access?
- Arteriovenous graft
2. Arteriovenous Fistula
What is the preferred type of vascular access?
AVF (arteriovenous fistula)
AV Fistula
access is the patients own artery surgically connected to a vein
What are the advantages to an AVF? (5)
- Decreased Thrombosis
- Less Infection
- cost lower
- Morbidity and Mortality decreased
- Increased life of access and good blood flow
Disadvantages to an AVF? (4)
- increased maturation time
- vein may fail to enlarge
- difficult cannulation
- enlarged vein perceived as unattractive
New Arteriovenous fistula Considerations: (3)
- only expert cannulators may place needles in a new AVF
- A maturation assessment of a new AVF should be completed at 4 WEEKS
- CVC should be removed after 6 consecutive successful cannulations with 2 needles and the prescribed BFR has been met
Arteriovenous GRAFTS:
is artificial tubing connected one one end to the patients vein and the other end to the patients artery
AV Grafts may be ____, ____, or _____ and may be located in the lower arm, upper arm thigh or chest.
LOOPED
STRAIGHT
CURVED
Advantages to an AVG include: (4)
- Large surface area to cannulate
- easy to cannulate
- healing time short
- easy to implant, construct, and repair
Disadvantages to an AVG include: (2)
- increased infection, thrombosis, stenosis, pain with creation
- expected to last 2 years
AVG considerations: (2)
- site rotation is essential and prevents one site itis, which will decrease the AVG life
- never place needles in a PSEUDOANURYSM
Patient Teaching for the AVF and AVG includes (12)
- PROTECT ACCESS FROM INJURY
- REPORT S/S OF INFECTION
- FEEL FOR THE THRILL DAILY AND REPORT CHANGES>
- KEEP CLEAN AND DRY
- BRUSING MAY OCCUR
- avf and avg for dialyisis only
- no bp access in the arm
- do not cover during dialysis
- apply pressure gently post dialysis
- notify staff of bleeding-line separation
11, pain - preform excecising for avf maturation
when cannulating a VASCULAR ACCESS it is necessary to wear PPE. This includes wearing PPE such as ____, ____, and _____ or ______.
Gloves
gowns
face shields or mask and goggles
_______ is the #1 infection control practice for reducing the transmission of disease.
handwashing
Patients should be instructed to ____ their access site for one full minute prior to dialysis
wash
Four components of vascualr access assessment:
- patient interview
- inspection (look)
- Auscultation (listen)
- Palpation (feel)
AVF/AVG patient interview: (4)
- Pain or bleeding?
- Numbness or Tingling?
- Medication Changes?
- Checking thrill daily? Any changes?
AVF/AVG Inspection:
Name at least 3 things the DPC staff would look for during the evaluation of an AVF or AVG?
- SKIN COLOR
- INCISION CLEAN DRY INTACT
- ABSENSENCE OF INFECTION
- prior cannulation site problem free
- compare to other arm (limB)
Give some abnormal findings while inspecting the AVF AVG:
- S/S OF INFECTION
- CHANGES IN THE EXTREMITY
- ANEURSYM/PSEUDOANEURSM
- BRUSING / HEMATOMA
- skin integrity issues
- collateral vein distention
- steel syndrome
AVG/AVF Ausculation:
A normal bruit would sound _____ and have a high continuous ______ sound.
low pitched
whooshing
AVG/AVF Ausculation:
An abnormal bruit might have a _____ or ____________.
High Pitched
no sound or Decreased Whooshing sound
Determine ________ through the access by compressing middle of vessell or graft and assessing bruit (listening) and thrill (feeling).
The bruit and thrill on the ______ side sounds louder and feels stronger.
DIRECTION OF BLOOD FLOW
Arterial
AVF/AVG palpation:
a vibrating sensation that can be felt in the access is called a ______.
Thrill
AVF/AVG palpation:
An abnormal thrill may have a _________ or be completely absent.
pounding choppy pulse