A 30 y.o. female patient is undergoing hemodialysis with an internal arteriovenous fistula in place. What do you do to prevent complications associated with this device?
A. Insert I.V. lines above the fistula.
B. Avoid taking blood pressures in the arm with the fistula.
C. Palpate pulses above the fistula.
D. Report a bruit or thrill over the fistula to the doctor.
Correct Answer: B. Avoid taking blood pressures in the arm with the fistula.
Don’t take blood pressure readings in the arm with the fistula because the compression could damage the fistula. Do not let anyone put a blood pressure cuff on the access arm. An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible.
Option A: IV lines shouldn’t be inserted in the arm used for hemodialysis. Untreated veins cannot withstand repeated needle insertions, because they would collapse the way a straw collapses under strong suction.
Option C: Palpate pulses below the fistula. Ensuring to check the access for signs of infection or problems with blood flow before each hemodialysis treatment, even if the patient is inserting the needles. Watch for and report signs of infection, including redness, tenderness, or pus.
Option D: Lack of bruit or thrill should be reported to the doctor. Check the thrill in the access every day. The thrill is the rhythmic vibration a person can feel over the vascular access. Do not wear jewelry or tight clothes over the access site. Do not sleep with the access arm under the head or body.
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