The client with an arteriovenous shunt in place for hemodialysis is at risk for bleeding. The nurse would do which of the following as a priority action to prevent this complication from occurring?
A. Check the results of the PT time as they are ordered.
B. Observe the site once per shift.
C. Check the shunt for the presence of a bruit and thrill.
D. Ensure that small clamps are attached to the AV shunt dressing.
Correct Answer: D. Ensure that small clamps are attached to the AV shunt dressing.
An AV shunt is a less common form of access site but carries a risk of bleeding when it is used because two ends of an external cannula are tunneled subcutaneously into an artery and a vein and the ends of the cannula are joined. If accidental connection occurs, the client could lose blood rapidly. For this reason, small clamps are attached to the dressing that covers the insertion site to use if needed.
Option A: Use of heparin to prevent clotting in bloodlines and hemofilter alters coagulation and potentiates active bleeding. Administer protamine sulfate as appropriate. It may be needed to return clotting times to normal or if heparin rebound occurs (up to 16 hr after hemodialysis).
Option B: The shunt site should be assessed at least every four hours. Apply external shunt dressing. Permit no puncture of shunt. Minimizes stress on cannula insertion site to reduce inadvertent dislodgement and bleeding from site. Verify continuity of shunt and/or access catheter. Disconnected shunt or open access permits exsanguination.
Option C: Checking for a bruit and thrill is done to monitor the patency of the shunt. Assess for oozing or frank bleeding at access site or mucous membranes, incisions, or wounds. Hematest and/or guaiac stools, gastric drainage. Systemic heparinization during dialysis increases clotting times and places the patient at risk for bleeding, especially during the first 4 hr after the procedure.
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