AVfistula care

hi there everyone. being new in renal nursing is really tough for me. would somebody please tell me the nursing care of patients' who had fistula formation? i had this patient last week who had bled a lot after he came back from operatin room.

can anybody help me please with the difference between the vascath and tessio catheter?

thanks very much!:)

hello anai, and welcome to allnurses !!!:balloons: :) :balloons:

it is not uncommon for a patient to bleed sometimes rather heavily post fistula placement. there is a lot of edema in the arm pushing against thoses stapels and sutures. was this patient on coumadin at all ? anopther thing to consider.

until the bleeding slows down (usually 24-48 hours post op), and for one or two dialysis treatments thereafter, i would cut his heparin bolus waaaaaaaaaay back.. or not give it at all, and flush his dilayzer q 1/2 hr. with ns instead... adding the flushes into your total goal of fluid removal.

that will assist to stop the bleeding around the incision site as well.

there are so many types of caths out there, it's hard to keep up with them all. some are made of different materials, and some should not be treated with betadine, etc.... you might do a google search and check out the differences.

good luck, and don't hesitate to ask... someone here will surely be able to answer.. or at least guide to to a place to obtain the answer you seek !

Issues:

Check "bruit" post op

Ensure dressing is firm but not tight

Check every 30mins first 24 hours

Avf arm must be elevated to stop swelling

Check for increasing haematoma, hand temperature and hand sensation and colour

Check for any signs of infection

Stop asprin if on it or any anti-platelet drug

Minimal heparin or stop for 2 hdx sessions then review.

Saline flushes if no heparin use (ensure fluid assessment is correct you dont want to overload patient)

Check HB

Vascath could either be temporary or permanent. Tessio lines are permanent lines and in some units are not use very often. Always be careful with infection when using lines. Exit sites must be monitored for any redness and signs of infection. Cap off as with your unit's protocol.

And also, don't let the pt. sleep on that arm. We get SEVERAL pts. back because they were sleeping on that arm post-op.