marking Dialysis Accesses

[BeckieRN]

I am manager of an acute Dialysis program and have concerns regarding cannulation of accesses following revisions and graft thrombectomies. Do any of you have specific policies or procedures in effect that require the surgeon or Interventional radiologist to mark the access (location for safe cannulation) after they have done a revision or de-clot? Any info would be appreciated.

[jnette, ASN, EMT-I]

Although I don't work acute, our patients will have to be declotted occasionally, or other revisions made.

We never have them marked.. never had the need... actually, never heard of this being done anywhere...

[BeckieRN]

The reason I am asking is that we frequently declot or revise an access and then need to cannulate that same access within 8-12 hours post-operatively. I am trying to develop a plan that the nurses cannulate in a "safe zone" with minimal calls to the vascular surgeon.

[jnette, ASN, EMT-I]

Originally posted by BeckieRN

The reason I am asking is that we frequently declot or revise an access and then need to cannulate that same access within 8-12 hours post-operatively. I am trying to develop a plan that the nurses cannulate in a "safe zone" with minimal calls to the vascular surgeon.

I still don't understand any need to mark a "safe zone"... if it is a declotted cath, it should be accessed as usual... no changes. The only thing you want to avoid is any pseudoaneurism areas... "puffy" or swollen areas of the access, where perhaps it has been stuck too many times as the "favorite spot".

Also, you want to stay an inch away from either end of the graft... you can feel this with your fingers.

I know this isn't much help.... but as I said, it shouldn't be a problem either way. Sorry... wish I could be of more help.

Perhaps there are some acute nurses out there who do something along those lines?

[ageless]

Our vascular surgeons most often draw a picture of the access with safe zone markings in the progress notes of the patients' charts.