AV Graft reverse cannulation

happybunny1970 · Sep 24, 2007

What?? On a Graft?? That would never fly in my (Acute) unit... Sounds like the venous/upper end is stenosed or otherwise blocked, causing the high pressures. But if the pressure can be reduced by manipulating the arm, seems like the better choice would be to talk to the patient and get their cooperation in positioning. I mean, what if they just decide that since it "ran OK" with the lines reversed that they don't need that study after all?

They may have completed the treatment, but I can't see how that patient actually got a GOOD treatment, if you know what I mean...

GeauxNursing · Sep 24, 2007

yea i kind of agree, but Im not a nurse yet, and def. not the charge nurse. i tend to keep my thoughts to myself when these things come up, although i am usu. right.

DeLana_RN, BSN, RN · Sep 28, 2007

So we have this upper arm graft. A loop, I suppose, like a sideways U-shape. at the full 400 BFR, we get great arterial pressure, never above -120. the venous tends to run high, depending on the position of the arm, the stick, etc. today it was running a high venous, 300. the tech working with him informed the CN that she was going to switch the lines, pulling from the venous and pushing back into the arterial. i have heard about recirc studies and the importance of NOT recirc-ing. but if the flow was better this way, was it ok to do? the CN was informed and gave her permission. The pt is scheduled for a fistulogram.

Huh? A VP of 300 indicates stenosis, so how would it be better to pull from that (even if it were good practice for an upper arm AVG, which it is not - recirc!)

DeLana

penem10 · Oct 1, 2007

We have used this in a desperate situation. When multiple attempts at cannulation have been made and no success. When the interventional radiologist is not available to do a fistulagram, or when the vascular surgeon is not available to place a cath. I have been told that they just do not as good a treatment. It is not something I'd do regulary, but at least the patient gets the fluid off to keep them out of the ER and out of trouble, temporarily. We always give a call to the MD or NP to let them know the trouble we had and what is going on.

This patient needs a fistulagram and the stenosis opened up to keep this graft working properly.

dialygal · Oct 8, 2007

First step is to make sure the venous side is actually the venous side. Do this when the patient is running on the machine with BFR as prescribed. With your fingers, occlude the AVG in the middle of the loop. If the machine alarms, you know you have your sides reversed. If it runs, then you are correct and the patient needs intervention. You did not mention what the bruit sounded like, but did mention high venous pressures as a usual occurrance. Pay close attention to the quality and pitch of the bruit. A high pitch or change in quality is a warning sign and should be reported immediately. Hope this helps!

GeauxNursing · Oct 8, 2007

well i'm not sure if he ever got in for the fistulogram, but he has been my pt the last week and I have had great flows all times, never above a 220 venous pressure.(i do credit myself with being a good sticker!)

Dialysis RN1 · Nov 22, 2007

Adequacy of dialysis would be greatly diminished if lines were reversed, but did anyone think that the stick was not good? It could have just been a poorly placed needle.

CocoaGirl · Nov 30, 2007

I have never seen or heard of an upper arm graft being reversed, they are usually "C" shaped or straight. Arterial is always the lower portion and venous the upper portion, if you reverse the lines all you will accomplish is recirculation. Sounds like a stenosis.

GeauxNursing · Dec 1, 2007

Adequacy of dialysis would be greatly diminished if lines were reversed, but did anyone think that the stick was not good? It could have just been a poorly placed needle.

see that is what I said, it was just probably a bad stick. but NO. we had the "best" sticker doing it. whatever, it ended up just being a bad stick, bc i got it fine every day thereafter.