BP on dialysis vascular access arm? What happens?

[Trubie, LPN]

New grad here, please forgive my questions :)

I have always been taught to NEVER NEVER NEVER take a blood pressure on the vascular access arm of a dialysis patient (also no blood draws from that arm). My question is.... what would happen if someone does? I understand that this site is their lifeline, of course that should not be compromised. But if an nurse/aid/family member does a BP without knowing it is contraindicated, what can happen to the patient/site??

Thanks! I just started working LTC and I have a few dialysis patients. I always worry about the "what if's"!

[Boog'sCRRN246, RN]

Dialysis patients are usually pretty protective of the arm that has their fistula, so I doubt that they'd let anyone with a BP cuff get close enough to that arm to try.

[thestrella]

If a nurse get a bp on a vascular site.. The fistula will be damage and it will be unusable. And in order to have a new fistula, a new site will be perform for dialysis to be continue.

[HiHoCherry-O]

As thestrella mentioned, the fistula could be damaged. Fistulas are created surgically. If it is damaged, the patient would need to have a permacath placed (which may be difficult due to the likelyhood of scarring from prior permcaths).

Once the fistula is placed, it has to mature which can take several weeks to months depending on the patient's vasculature (and compliance with following exercises to aid in maturation).

Not all fistula placements are successful. In this case, a new fistula site may need to be selected and the surgery done again. All this time, the patient still needs to have dialysis. Catheters can last a long time but are also a big risk for infection.

As mentioned by Boog, most patients and family members are well aware of not letting anyone do BP or blood draws on the side of the fistula. But just keep in mind the potential for complications (long term wise) if these tasks are done on that arm (or leg sometimes) and the fistula (or graft, which is placed if patients vasculature is too small for a fistula) is damaged.

[anurseadvocate]

New Grad,, good for you for asking... having worked in health care for some thirty years, there are many who would not ask.. any question is a good question and shows that the person asking cares.... good for you. :)

[traumaRUs, MSN, APRN]

As everyone states, its not a good idea because if you circumferentially compress a fistula or graft, it can clot, forcing the patient to undergo a thrombectomy to angioplasty procedure to get rid of the clot.

Most dialysis pts/families are very aware of not allowing anyone to touch their access arm.

As above poster indicated, no question is is useless. Good luck.

[diabo, RN]

plus the BP may not be accurate due to various circulatory reasons.

We really shouldn't take BPs around the neck either. (sorry, my grand daughter makes me say silly things sometimes) {)

Steven

[Dudeas]

Just want to add more to the information.

You don't do it because a fistula is a connection between arteries and veins...average BP in arteries is 120/80, average BP in veins is 5/5...blood flows by default from high pressure to low pressure...hence from arteries to the veins...so the artery loses blood and will falsely register a very low blood pressure.

Venous blood draws should not be done from the same arm because arterial blood is leaking into the vein of that arm and there is a mixture of blood contents so you will have all sorts of lab errors...technically I dont see problems with getting blood for ABG from the same arm as arterial blood remains unmixed but I'd avoid it anyway for risk of infection to the fistula.

Regarding damage to the fistula, it's unlikely, that's why you wait for the fistula to mature with fibrosis before you use it for a few months. They are quite resistant to being squished...the main issue is if there is major trauma like being hit directly on the fistula site then there is a lot more risk of continuation of fibrosis which always has a risk of fibrosis growing into the inside of the blood vessel which is then a risk factor for loss of patency between the arteries and veins. There is also as others mentioned risk of thrombosis formation in the vessels as well which increases with being squished for a long time or if there is some trauma to the inside the blood vessels.

I hope this helps.

[diabo, RN]

Obviously an upper arm fistula or graft is out of the question, especially because of the location of the anastomosis. The blood flow should never be cut off for any reason. This includes holding pressure to stop the stop the bleeding, or improper use of clamps. In the latter, blood flow should be confirmed above the clamp. Personally I feel, and many doctors agree, clamps should never be used because of the possibility of damage to the access.