Fistulas/ Grafts

[JEEE]

Hello!

I hope everyone is doing well.

I am new to dialysis and it is my first RN job.

What are some assessments for fistulas and grafts I need to keep in mind, that is reportable to the doctor.

For example, I had an incident where pt's fistula had a scab that was open, I called the doctor, ordered me to stick away from the scab and instruct pt to go to the ER after tx.

Thank you! :)

[Loveyourkidneys]

Report and redness or pain. You should listen before sticking EVERYTIME (however it rarely gets done in the real world) report any hand numbness or pain on access arm (although it isn't alway abnormal) report excessive post tx bleeding for more than 2-3 txs. Arterial side should always sound louder than venous side. If you can't tell which side is arterial occlude at the anastomosis and then listen. Venous should be almost absent bruit with occlusion. Tourniquet should be used with fistulas. Always alway always butterfly tape your needles down. And never allow PTs to cover the access with blankets. They will gripe and whine but eventually comply. Chart EVERYTIME you ell them to keep it uncovered if they are one of those that cover it. We coded a lady should dislodged her venous needle. Charting pt education about keeping uncovered saved our tails :)

[JEEE]

Thank you! :) Well-written.

[idodialysis]

Also you should be monitoring the venous pressures in the access routinely to help wit early detection of stenosis in the access. Access flow monitoring is helpful if your clinic can do this.