A client has a history of chronic renal failure and received hemodialysis treatments three times per week through an arteriovenous (AV) fistula in the left arm. Which of the following interventions is included in this client’s plan of care?
A. Keep the AV fistula site dry.
B. Keep the AV fistula wrapped in gauze.
C. Take the blood pressure in the left arm.
D. Assess the AV fistula for a bruit and thrill.
Correct Answer: D. Assess the AV fistula for a bruit and thrill.
Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. Thrill is caused by turbulence of high-pressure arterial blood flow entering a low-pressure venous system and should be palpable above the venous exit site. Bruit is the sound caused by the turbulence of arterial blood entering the venous system and should be audible by stethoscope, although may be very faint.
Option A: When not being dialyzed, the AV fistula site may get wet. Avoid contamination of the access site. Use aseptic technique and masks when giving shunt care, applying or changing dressings, and when starting or completing dialysis process. Prevents the introduction of organisms that can cause infection.
Option B: Immediately after a dialysis treatment, the access site is covered with adhesive bandages. Assess skin around vascular access, noting redness, swelling, local warmth, exudate, tenderness. Signs of local infection, which can progress to sepsis if untreated.
Option C: No blood pressures or venipunctures should be taken in the arm with the AV fistula. Avoid trauma to shunt. Handle tubing gently, maintain cannula alignment. Limit activity of extremity. Avoid taking BP or drawing blood samples in shunt extremity. Instruct the patient not to sleep on side with shunt or carry packages, books, purse on affected extremity.
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