Caring for a Hemodialysis Shunt, Graft, Fistula

Transcription

1 Caring for a Hemodialysis Shunt, Graft, Fistula Skill Lab ( 5 ) Presented by : MASHAEL HASAN RN,BSN

2 Outlines : Purpose Equipment Assessment Outcome Identification Implementation Evaluation Documentation

3 Introduction

4 Definition 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.

5 Purpose 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.

6 Description 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.

7 An AV fistula requires planning more than other kinds of access because it takes two to six months to develop.

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10 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.

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12 Other types of vascular access, such as catheters and shunts, are temporary forms of access.

13 Complications

14 Purpose of Caring for a Hemodialysis Shunt, Graft, Fistula Maintains patency & cleanliness of access for Dialysis. Detect Complications related to infection, occlusion, or Cannula separation at a hemodialysis access site.

15 Equipment Nonsterile gloves. Tow Paris of sterile gloves. Antiseptic cleansing agent or antiseptic swabs. Topical antiseptic, if ordered. Sterile 4X4-in gauze pads. Gauze warp. Cannula clamps.

16 Assessment Assessment should focus on the following: Policy regarding timing & procedure for site care/dressing change. Location of shunt, Graft, Fistula. Status of Graft, Fistula or cannula site & dressing. Vital signs.

17 Pulses distal to shunt, Graft or Fistula. Color & temperature of extremity in which access is located. Presence of pain or numbness in extremity in which access is located. Time of last dressing change Chronic illness or medications that may increase risk of infection or impair healing.

18 Outcome Identification Sample desired outcome include the following: A bruit is present on auscultation & a thrill is palpable. Client displays no edema, redness, pain, drainage, or bleeding at the hemodialysis access site.

19 Implementation Action Rationale 1- Perform hand hygiene. Reduces microorganism transfer. 2- Explain procedure to client. 3- Determine if client is allergic to iodine-based antiseptic & use alternative if indicate. Reduces anxiety; promotes cooperation Avoids allergic reactions

20 Action Rationale 4- Open several packages of 4x4- in. gauze and soak several pads with antiseptic solution, or open antiseptic swaps and position for easy access. Keep one package of gauze dry. 5- Don Nonsterile gloves. 6- Lower side rails & position client to expose site. Remove old dressing, if present & check access site. Facilitates cleaning process; provides gauze to cover shunt. Prevents contamination of hand ; prevents exposure to body secretions. Expose access site

21 Action 7- Remove gloves with old dressing. 8- Perform hand hygiene & don sterile gloves 9- Cleanse access area with antiseptic agent recommended by agency.for shunt care begin at exit areas & work outward, discarding antiseptic swap or folded gauze pad after each wipe. 10- Lightly place two or three fingertips over access site and assess for presence of thrill (a palpable vibration should be present); assess site for extreme warmth or coolness Rationale Removes contaminated items. Reduces microorganism transfer; avoids site contamination. Cleanse s access site; Reduces contamination. Test for adequate blood flow through shunt.

22 Action 11- Apply topical ointment if ordered 12- Place dry sterile gauze pad over access site. 13- for shunt apply gauze wrap over gauze pads & around extremity (wrap firmly enough that dressing is secure but not so tight as to occlude blood flow) and tap securely leave small piece of shunt tubing visible. 14- Remove gloves and discard with soiled martials ; perform hand hygiene. 15- Position client for comfort ; rise side rails and place call light within reach. Rationale Prevents infection Reduces site contamination. Prevents accidental dislodgment of cannula; allows for visualization of continuous blood flow. Reduces microorganism transfer. Promotes comfort: promotes safety ;facilitate communication.

23 Action 16- Assess status of dressing ;access site; and pulses in affected extremity every 2 hr. 17- During immediate postoperative period ; inform client,family, staff of the following care instructions: I f shunt is in arm or leg, keep extremity elevated on pillow until instructed otherwise. Keep extremity as still as possible. Do not apply pressure to or lift heavy objects with extremity ( if shunt is in leg crutches will be used for a short while when client become ambulatory.) Rationale Monitors frequently foe complications. Prevent loss of access site due to occlusion, infection, or cannula separation Prevents rupture or pain.

24 Action Do not allow access area to get wet during showering, bathing, or swimming. 18- Inform client, family, staff of the following care instruction : Never perform blood pressure assessment or any procedure that might occlude blood flow on affected extremity. Never perform veinpucture or any procedure involving a needlestick. Place sign over bed prohibiting use of affected extremity for this procedure. Rationale Promotes cooperation with care of site; reduce fear ; prevents injures. Prevents occlusion blood flow. Prevent injury, clotting, and infection.

25 Action Avoid restricting blood flow in affected extremity with tightfitting clothes, watches, name bands, knee-high stockings antiembolytic hose, restraints, and so forth. Notify nurse immediately if bleeding or cannula disconnection is noted. Apply cannula clamps if disconnection is noted. Rationale Prevents restriction of blood flow and injury to shunt /graft / fistula area. Prevents excessive bleeding. Prevents hemorrhage

26 Evaluation Were desired outcomes achieved? Example of evaluation include: Desired outcome met; A bruit is present on auscultation, and thrill is palpable. Desired outcome met; Client display no edema, redness, pain, drainage, or bleeding at the hemodialysis access site.

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28 Documentation The following should be noted on the client record : Location of access site. Status of site & dressing. Vital signs. Status of pulses distal to access area Color & temperature of extremity in which access is located. Presence of pain or numbness in extremity in which access is located.

29 Reference : NURSES GUIDE TO Clinical Procedures, 6 th Edition. Jean Smith-Temple, DNS, RN. Joyce Young Johnson,PhD,RN, CCRN