This action might not be possible to undo. Are you sure you want to continue?
A hemodialysis shunt, graft, or fistula provides vascular access for hemodialysis, a treatment that cleans the blood by removing wastes and excess water from the body.
Kidneys remove wastes from the blood through the urine, regulate the amount of water and minerals needed by the body, and produce hormones. When the kidneys lose their ability to filter wastes and excess water from the blood, hemodialysis is required. During hemodialysis, the blood is circulated through a hemodialysis (artificial kidney) machine. Hemodialysis cleans blood similar to the way kidneys do. A vascular site, such as an arteriovenous (AV) fistula or graft, provides access for the removal and return of blood during hemodialysis. The patient's blood is removed and circulated through a machine that contains a dialyzer. The wastes and excess water from the patient's blood pass through the dialysis machine's membrane into the dialysate, and are then discarded. The dialyzed (cleaned) blood is returned to the patient's bloodstream.
The patient is attached to the hemodialysis machine through several means. The most common method of providing permanent access to the bloodstream for hemodialysis is an arteriovenous (AV) fistula. An AV fistula is created surgically by connecting an artery to a vein, usually in the forearm. An AV fistula requires planning more than other kinds of access because it takes two to six months to develop. During this time, the stronger blood flow from the artery causes the vein to become larger. This allows the fistula to take repeated needle insertions, and for blood to flow quickly to the dialyzer. Another way to provide vascular access to the bloodstream is through an internal graft surgically connecting an artery to a vein with a synthetic or bovine graft placed under the skin. A hemodialysis graft does not need to develop as a fistula does and so can be used soon after it has been placed. Other types of vascular access, such as catheters and shunts, are temporary forms of access.
The primary complications of vascular access are clotting and infection. After an AV fistula has developed, it is less likely to form clots or get infected. Grafts typically have more problems with infection and clotting and need revisions or replacement sooner than fistulas. Proper hemodialysis depends on fistulas and grafts that work well. To preserve and protect AV access:
Keep the access site clean at all times to prevent infection.
or at home. Hemodialysis is a fast and efficient method for removing urea and other toxic products and correcting fluid and electrolyte imbalances but requires permanent arteriovenous access. Results AV fistulas usually last longer and have less complications than other kinds of vascular access.scribd. provides permanent vascular access for hemodialysis. blood is shunted through an artificial kidney (dialyzer) for removal of toxins/excess fluid and then returned to the venous circulation. The type of vascular access selected for patients depends on their individual needs such as vein size.enotes. Careful assessment and use of preventive measures help ward off problems. DO . Procedure is usually performed three times per week for 4 hr. outpatient dialysis center. sleeping on. usually in the forearm. such as infection and thrombosis.com/doc/17471581/Nursing-Care-Plan-for-HEMODIALYSIS Protecting a hemodialysis fistula A SURGICALLY PLACED arteriovenous fistula. http://www. http://www. Check for signs of infection at the access site.y y y y y y Avoid injections. Check the temperature and color of the fingers and thepulse of the access arm for adequate circulation. Health care team roles The health care team can help patients prepare and maintain their vascular access. intravenous (IV) needles or fluids. HD may be done in the hospital.com/nursing-encyclopedia/hemodialysis-shunt-graft-fistula-care HEMODIALYSIS In hemodialysis (HD). or taking blood samples in the access site arm. Do not take blood pressure or put pressure on the access arm. Needle insertions for hemodialysis treatments should be rotated so that one spot is not repeatedly stuck and weakened. Blood is withdrawn through the arterial segment and reinfused through the venous segment. or lifting heavy objects with the access arm. Advise patients to avoid wearing jewelry or tight clothing. The health care team provides the information and support for patients and families on how to preserve and protect their vascular access.
ischemia. Both the thrill and the bruit result from arterial blood rushing into the vein. * Check the fistula for balloonlike pseudoaneurysms. Some patients with an impaired sense of touch can learn to assess fistula patency by listening for a bruit at the site. Tell him to report any problems immediately. especially the area of anastomosis. Have your patient demonstrate his ability to determine fistula patency by palpating for a thrill. DON'T * Don't use the fistula to administer IN. which could compromise its integrity and patency. * Don't put any excessive pressure on the affected arm. * Show him sleep positions that'll keep his body weight off the arm with the fistula. Feel for a thrill by palpating the fistula. * Teach him not to carry heavy items such as grocery bags and not to wear tight-fitting clothing over the access arm. including pain. These procedures could contribute to infection and clotting in the fistula. fluids. coldness. or excessive warmth. http://findarticles. and thrombosis. If edema fails to resolve or recurs. impaired motor function. Edema is usually normal for up to 2 weeks after a fistula is created. redness. * Make sure he knows the signs and symptoms of infection. * Assess the fistula for signs and symptoms of infection. or decreased sensation in the arm and assess for decreased distal arterial pulses-all may signal ischemia. * Don't take blood pressure readings or perform venipuncture on the access arm. * Document your findings and patient teaching in the medical record. and listen for a bruit by auscultating the area with a stethoscope. notify the health care provider. tingling. swelling.com/p/articles/mi_qa3689/is_200211/ai_n9162933/ Hemodialysis Access Care & Management y hemodialysis . * Ask your patient if he has numbness.* Assess the arm with the fistula.
What is an ArterioVenous Fistula (fistula)? An AV fistula is when an artery is directly connected to a vein. but a large portion of it returns through the vein. a nurse will stick 2 needles into the fistula. hemodialysis is the process that kidney doctors use to perform the functions normally performed by the kidney. The second best option is an arteriovenous graft (AV graft). blood is pumped under high pressure through arteries away from the heart. This process is called maturation. Once the fistula is mature (typically 6-8 weeks). In order for the machine to work. Blood is returned under low pressure through veins back to the heart. This creates very high blood flow through the vein. At the dialysis center. Patients requiring hemodialysis usually require several dialysis access procedures over the course of their life. it needs a large amount of the patient s blood to circulate between the machine and patient. 3 times a week. and maintain the correct pH. so some of the blood continues through the arteries. The 3rd and last option is a tunneled dialysis catheter. fluid and electrolytes levels in the blood. At the hemodialysis center. . patients are connected to a machine that can perform these functions. Vascular surgeons provide access for hemodialysis (to achieve the high rate of blood flow required). When the kidneys fail to work properly. The fistula is like a short circuit. and over time (weeks) the vein dilates and the wall of the vein thickens. remove toxins. The second needle returns the filtered blood back to the patient. it can be used for hemodialysis access. If you are a candidate. none of these options are going to last forever. This process occurs for 3-4 hours. Although AV fistulas can last many years. a kidney transplant is a better long-term option than hemodialysis. What are the options for hemodialysis access? The best option for long-term hemodialysis access is an arteriovenous fistula (fistula). One needle will drain blood out of the patient and into the dialysis machine so the blood can be filtered. Normally.Hemodialysis Access What is hemodialysis? The kidneys filter our blood. depending on how old they are when they start hemodialysis.
but patients that get their hemodialysis from a catheter long-term will have a higher risk of death and hospitalization. This is done when the patient does not have a suitable superficial vein for the creation of an AV fistula. 3 times a week. One needle will drain blood out of the patient and into the dialysis machine so the blood can be filtered. Some patients want to have a dialysis catheter to avoid getting stuck with needles. but will achieve higher flow rates. What is a dialysis catheter? A dialysis catheter is a tube with 2 channels. The second channel returns the filtered blood back to the patient. except an artificial graft (a tube made out of Teflon) is sewn at one end to an artery. so nothing sticks out of the patient. An AV graft is not as effective as an AV fistula. The dialysis catheter can be used immediately after insertion. One channel will drain blood out of the patient and into the dialysis machine so the blood can be filtered.An AV fistula takes longer to get ready for dialysis access. This process occurs for 3-4 hours. The graft is tunneled underneath the skin. This process occurs for 3-4 hours. a nurse will connect the dialysis machine to each of the 2 channels in the catheter. but better than a catheter. The second needle returns the filtered blood back to the patient. and patients will have an improved chance of survival compared to other methods of hemodialysis access. and the other end is sticking outside the patient. the AV graft can be used approximately 3 weeks after insertion. and a . and the other end to a vein. In this case. The tube is inserted into one of the large central veins in the neck so that its tip is in the chest. will have a lower rate of infection. lower rate of failure. At the dialysis center. 3 times a week. At the dialysis center. What is an AV graft? An AV graft is similar to an AV fistula. a nurse will stick 2 needles into the AV graft.
Up to one-third of the AV fistulas will not mature. or vein is too small. and the fistula needs to be revised. Sometimes the artery. Instead of 1 small incision. and they may need minor secondary operations to get the fistula to work well enough. In addition to the local numbing medicine. the fistula can work too well. the fistula needs to be abandoned. If the hand is not getting enough blood. How is a fistula made? Most of the time. It is still usually done under local anesthesia. How is a AV graft inserted? AV grafts are inserted in a similar fashion as AV fistulas are created. Catheters are considered acceptable for short-term dialysis. usually 2 small incisions are made. it will become numb. and monitor the patient to make sure they are comfortable. Steal from an AV fistula is uncommon. but the chances of bleeding and infection with the creation of an AV fistula or AV graft are rare (1-2%). a risk of bleeding and infection are possible.higher risk of the catheter getting infected or failing. an anesthesiologist will administer sedative medicine into a vein. Sometimes. and then allowed to go home. . it is sewn indirectly to the artery using an artificial graft (tube usually made out of Teflon). it can be fixed with another small procedure that will preserve the fistula (an arm bypass). The other main risks are that the fistula will either not work well enough. What are the risks of the operation? The risks of the operation are relatively low. and occurs more commonly in upper arm fistulas compared to forearm fistulas. If steal occurs. but are rarely ideal for long-term dialysis. since the physiologic stress of the operation is low. or it will work too well. and can be performed comfortably with a local anesthesia (local numbing medicine similar to what a dentist would use). a fistula can be made with a small (2-3 inch) incision in the arm. and sometimes scar tissue develops. The operation is a small stress on the body. As with all operations. and steal blood from the hand. weak or painful (much more than the other hand sometimes diabetes can cause these symptoms as well). and a new site selected. Patients are usually observed for 45 minutes to 1 hour after the procedure. and patients usually go home the same day. Instead of sewing one of the patients veins directly to the artery. Other times.
blood goes through a tube from the body to a dialyzer. the clean blood travels through another tube and back into the body. the access would be in your left arm. Who needs hemodialysis? If your kidneys fail. you will need dialysis or a kidney transplant to live. There are three types of access: . Your doctor can help you decide which treatment is best for you. An access (also called vascular access) is the place on your body where this happens. This means that if you are right-handed. and returned to your body.edu/vascular-endovascular-surgery/hemodialysis-access-care-management What is hemodialysis? Hemodialysis is a way of cleaning wastes and extra fluids from the blood using a machine. wastes and extra fluids are cleaned from the blood.arizona. Another kind of dialysis is peritoneal dialysis. An access is usually in the arm that you don¶t write with. cleaned. Then. blood must be taken from your body. Hemodialysis is the most common kind of dialysis. Inside the dialyzer. The dialyzer is the machine¶s filter. Click here for more information about peritoneal dialysis. In hemodialysis.surgery. What is an access? For hemodialysis.http://www.
This lets you have dialysis. It is least likely to get clots or infections. They are more likely to be infected or get clots. A fistula is the best kind of access.1. 2. but catheters are more likely to have . The surgery connects an artery and a vein in your arm. 3. your doctor will do minor surgery. needles will be put into the graft to remove the ³dirty´ blood and return the ³clean´ blood. To make a fistula. Fistulas often last longer than other kinds of access. Grafts are not as safe as fistulas. There are no needle sticks. Fistula This is also called an AV (arteriovenous) fistula. For dialysis. Talk to your doctor about your options. Catheter A catheter is a tube that goes directly into a vein in your neck or leg. During dialysis. the machine is attached directly to this tube. It can take 1 to 4 months for the fistula to be ready for dialysis. For dialysis. Graft A graft is a special tube that connects an artery and a vein in your arm. That is why it is important to plan ahead. needles will be put into the fistula to remove the ³dirty´ blood and return the ³clean´ blood.
) Make sure that your dialysis technician or nurse checks your access at each treatment Tell your doctor right away if you notice any swelling.infections and problems with clotting. no matter which kind you have. dry and bandaged Clean and re-bandage the area at each treatment (Make sure that you know how to do this at home in case the bandage becomes wet or dirty between treatments. How should I care for my access? Your access lets you have the treatment you need to live.) . Catheters are only recommended for emergencies or short-term use. redness or other changes in your access To care for a catheter: Make sure that all clamps are closed and caps are on tight Protect the area from water and dirt as much as possible Keep the area clean. It is very important to take good care of your access. To care for fistulas and grafts: Keep the area clean Use your access only for dialysis Do not have blood tests or check blood pressure in your access arm Avoid wearing tight clothing or jewelry over your access area Protect your access from bumps and cuts Avoid lifting heavy objects Try not to lay or sleep on your access Learn how your needles will be placed for dialysis (The staff at your dialysis center can help you with this.
homedialysis.Tell your doctor right away if you have a fever or notice any swelling. How long does hemodialysis take? Hemodialysis usually takes three to five hours each time. you will sit in a special chair. In some cases. This means that you and a partner must be trained for it. staff at the dialysis center will check your weight and blood to make sure that you are getting enough dialysis. Your doctor can make changes to your dialysis if needed. What can I do during hemodialysis? During hemodialysis. For more information about home dialysis. A few things to know about in-center hemodialysis are: You may need to have help getting to and from the dialysis center. redness or other changes around the access Where can I have hemodialysis? Hemodialysis can be done at a dialysis center (sometimes called ³in-center hemodialysis´) or at home. Once you have started your treatment schedule. Some centers have special exercise equipment for dialysis patients. Your doctor will decide how long and how often you need dialysis. Some dialysis centers have more flexible treatment hours than others. .org. Your doctor might only use a few dialysis centers in your area. visit Home Dialysis Central at www. Both home hemodialysis and in-center hemodialysis have their pros and cons. Your doctor and the staff at your dialysis center can help you decide which is best for you. Most patients will need treatment at the center three times a week. Most patients need to have hemodialysis three times a week. Many dialysis centers have staff who can train patients for dialysis at home. Other options might be to: y y y y y y y y Talk to other patients Read a book Listen to music or a book on tape Play hand-held video games Do crossword puzzles Write letters Take a nap Exercise. Many dialysis centers have TVs for patients to watch. hemodialysis can be done at home.
A kidney friendly diet can help you feel better and avoid other problems. How will I need to change my diet? Dialysis is not a cure. Too much of this can be dangerous. http://www. Chemicals and fluid from the foods you eat can build up between treatments.kidneyfund. Dialysis does not work as well as healthy kidneys.You can also talk to the staff at your dialysis center for other ideas of things to do during your treatments.html .org/kidney-health/kidney-failure/hemodialysis.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.