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SKILL 12-14 Caring for a Hemodialysis Access (Arteriovenous Fistula or Graft) Goal: The patient verbalizes appropriate care

measures and observations to be made, demonstrates care measures, and the graft or fistula remains patent. 1. Identify the patient. Explain procedure and encourage patient to observe or participate if possible. 2. Close curtains around bed and close door to room if possible. 3. Perform hand hygiene. 4. Inspect area over access site for any redness, warmth, tenderness, or blemishes.
Palpate over access site, feeling for a thrill or vibration. Palpate pulses distal to the site. Auscultate over access site with bell of stethoscope, listening for a bruit or vibration.

5. Ensure that a sign is placed over head of bed informing the healthcare team which arm is affected. Do not perform a venipuncture or start an IV on the access arm. 6. Instruct patient not to sleep with the arm with the access site under head or body. 7. Instruct patient not to lift heavy objects with or put pressure on the arm with the access site. Advise the patient not to carry heavy bags (including purses) on the shoulder of that arm. 8. Remove gloves and perform hand hygiene. 9. Document assessment findings and any patient education performed.

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