Infiltration
swelling at the needle insertion site on the venous needle.
pain at the needle insertion site.
What do you suspect happened?
Causes?
infiltration
movement, cannulation
stop pump, notify nurse, re-cannulate, cold pack
how often is access flow done?
once a month
After thrombosis, the arm is visibly swollen. What are the next steps?
notify nurse, do not cannulate
Needle dislodgement
Causes- not taped, pt movement
bleeding
stop pump, check bp, give NS if needed, complete adverse event report if needed
Feel the
Thrill
What if there is a infiltration?
Add a cold pack, re-cannulate above or below
What is a normal access flow for an AV graft?
greater than 600ml/min
The RN comes to assess the access and confirms there is no bruit or thrill. What do you suspect is wrong with the access?
Thrombosis
Late failure of AV graft
thrombosis, stenosis
s/sx-high venous pressures, no bruit,
referral to surgeon, possible alternative access, abx
What are the 4 components of the one-minute access check?
look, listen, feel, ask
aneuryms- causes, s/sx,intervention
repeated cannulation
increase in vessel diameter, thinnning of skin,
When is a patient referred to vascular after access flow testing?
less than 25% from baseline
greater than 2000ml/min
What are potential causes of internal vascular access infections?
poor hand hygiene
not cleaning access site
what causes narrowing in the blood vessel?
s/sx
intervention?
overgrowth of the blood vessel tissue as the anastomosis, turbulent blood flow due to vessel wall injury, repeated cannulation
swelling of veins
possible balloon angioplasty
What if you aspirate clots during cannulation?
re-cannulate, use alternative active access
pseudoaneurysm-graft
repeated cannulation
swelling, painful, pulsatile
surgical intervention
What is a normal flow for AV fistula?
Greater than 400 ml/min
Thrombosis
causes, s/sx, intervention
stenosis, hypotension, prolonged compressions
no thrill or bruit, pounding pulse
could need thrombectomy
Access Rupture
Unhealed needle sites on aneurysms/pseudoaneurysms • Weakened skin • Accidental dislodgement of scab on buttonhole access
Profuse bleeding • Hypotension • Chest pain • Shortness of breath
calls 911, MD
What is a button hole technique?
Cannulation:
same angle, same location, every time
What can cause hematoma/infiltration?
Signs and symptoms
patient movement, initial infiltration
Bleeding from exit sire? high venous pressure, swelling at needle insertion
How do you start with the access flow lines?
reverse or normal?
normal
reverse
then normal
Vascular access infection
#1 cause of hospitalization
#2 cause of death in patients on hemodialysis 100% avoidable
poor infection control
fever swelling redness drainage
don't cannulate a fistula or graft if it appears infected
an elevated arm test- does not completely collapse
a whistle noise.
abnormal---Stenosis
new starts- what size needle and what BFR do they start?
17g and 300ml