A patient with ESRD has an arteriovenous fistula in the left arm for hemodialysis. Which intervention do you include in his plan of care?
A. Apply pressure to the needle site upon discontinuing hemodialysis.
B. Keep the head of the bed elevated 45 degrees.
C. Place the left arm on an arm board for at least 30 minutes.
D. Keep the left arm dry.
Correct Answer: A. Apply pressure to the needle site upon discontinuing hemodialysis.
Apply pressure when discontinuing hemodialysis and after removing the venipuncture needle until all the bleeding has stopped. Bleeding may continue for 10 minutes in some patients. The AV fistula is the safest type of vascular access. It can last for years and is least likely to get infections or blood clots. A surgeon connects an artery (a large blood vessel that carries blood from the heart) and a vein (a blood vessel that carries blood to the heart) under the skin in the arm. Usually, they do the AV fistula in the non-dominant arm.
Option B: Remove any restrictive clothing or jewelry from the arm. To prevent injuries, place an armband on the patient or a sign over the bed that says no BP measurements, venipunctures, or injections on the affected side. When blood flow through the vascular access is reduced, it can clot.
Option C: Perform hand hygiene before you assess or touch the vascular access. If it’s new vascular access with a wound, don gloves. Position the patient’s arm so the vascular access is easily visualized. Palpate the vascular access to feel for a thrill or vibration that indicates arterial and venous blood flow and patency.
Option D: Check the patient’s circulation by palpating his pulses distal to the vascular access; observing capillary refill in his fingers; and assessing him for numbness, tingling, altered sensation, coldness, and pallor in the affected extremity.
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