Learning process?

[DialysisNurseDA]

Hello

As u know I am a newbie. I start my position tomorrow. I am excited.

I have some more questions.

I've been reviewing the websites and reading about vascular assess. I know about the Lifesite I also know how the most DN and PT's feel about them. They do not like them. Funny how the website claims they are great, because the patient can get higher blood flows with them.

I have also, learned about the 3 other assesses; fistula, graft and catheter. The lifesit is also a catheter correct?

Is the fistula really the best? Then why do so many doctors use the graft is it because it matures faster like in about 6 weeks oppose to the fistula which takes 6 months? The graft is not as good as the fistula it usually needs more changes,

because a graft is an artificial material attached to the artery and the vein, it clots up more. It is not a piece of the body tissue the body rejects it and this can cause potential for infection. I read the catheter is only used temporarily.

Is there anymore vascular assess devices other than the ones I mention? What is the most use site in your facility?

What all does an RN do in dialysis?

Thanks for any help!

Darcy

[jnette, ASN, EMT-I]

Hi there !

Yes. a fistula is the preferred access as the patient is using his own artery and vein to provide the pressure needed for bloodflow rate. However, the patient must have a good artery and vein to accomplish this... to provide enough pressure for adequate bloodflow. With so many dialysis patients being diabetic, they will also have numerous peripheral vascular comorbidities. So a fistula is not always possible.

Second choice then, is the graft. These work quite well, really. They are tunneled under the skin of the arm. The drawback with grafts is that with constant use, they will "break down" with time. It is important to remember not to stick the graft in the same place each time, but to rotate your stick sites along the graft to prolong its longevity. Occasionally a graft will clot off and the patient will be sent to the surgeon who will clean it out or replace it if necessary.

The last option of course is the cath. The majority of new patients present with a temporary cath.. either IJ or subclavian.

The bloodflow is not nearly what it needs to be to provide GOOD dialysis with a cath, but it is adequate in most cases. The sooner the patient can use his fistula or graft, the better he will be dialysed.

There are some who have no adequate access sites or vascular options for either a graft or fistula. These patients will then have a permanent catheter. Rarely will you get a bloodflow greater than 300-350... and the better the bloodflow rate, the better the treatment. The docs like the BFR to be as close to 500 as possible. Most of our patients run between 450 and 500. Except for the caths, of course.

We have about even numbers of grafts and fistulas. 2 permanent caths, and of course several "new patient" caths who are waiting for their fistulas to stregthen.

The dialysis RN does pretty much everything...rather that repeat all this, I'd say go check out the other threads and posts on this forum.. you're in the right place... just go back to some of the past threads here over the months, and read through them. You'll get a pretty good idea of what we do.

I wish you the best. It will all seem pretty overwhelming at first... just learning to set up the machines and lines is a major task in itself. Don't be too hard on yourself if you feel you are not learning fast enough. There is just SO MUCH to learn and retain... give yourself plenty of time and take it in steps. You'll get there.

Keep us posted on your progress, your questions, joys, and concerns.

Looking fwd. to hearing from you again....:)