Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient?
A. The patient shouldn’t feel pain during initiation of dialysis.
B. The patient feels best immediately after the dialysis treatment.
C. Using a stethoscope for auscultating the fistula is contraindicated.
D. Taking a blood pressure reading on the affected arm can cause clotting of the fistula.
Correct Answer: D. Taking a blood pressure reading on the affected arm can cause clotting of the fistula.
Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm. For the most effective hemodialysis, the patient needs good vascular access with an arteriovenous (AV) fistula or an AV graft that provides adequate blood flow. 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 A: 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.
Option B: Auscultate the vascular access with a stethoscope to detect a bruit or “swishing” sound that indicates patency. Palpate the vascular access to feel for a thrill or vibration that indicates arterial and venous blood flow and patency.
Option C: Assess the vascular access for signs and symptoms of infection such as redness, warmth, tenderness, purulent drainage, open sores, or swelling. Patients with end-stage kidney disease are at increased risk of infection.
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