Caring for Hemodialysis PT

What is a vascular access in hemodialysis?

• Direct access to bloodstream

• Used to remove and return blood during dialysis

• Types:

  • AV graft

  • AV fistula

  • Dialysis catheter

What is an AV graft?

• Synthetic tube connecting artery → vein

• Surgically inserted

• Acts as a bridge for blood flow

What are advantages of an AV graft?

• Can be used sooner after placement ⭐

• Easier to access

• Higher blood flow → efficient dialysis

What are disadvantages of an AV graft?

• ↑ infection risk ⭐

• ↑ thrombosis (clotting)

• ↑ stenosis (narrowing)

• Steal syndrome (↓ blood to extremity) ⚠

• Shorter lifespan than fistula

What is steal syndrome?

• Blood diverted away from distal extremity

• Causes:

  • Pain

  • Decreased perfusion

  • Possible necrosis

What is an AV fistula?

• Artery directly connected to vein

• Uses patient’s own vessels

• Preferred access ⭐

Why is AV fistula preferred?

• Fewer complications ⭐

• Lower infection risk

• Longer lifespan

• Better patient outcomes

What are disadvantages of AV fistula?

• Takes 6–8 weeks to mature ⭐

• Harder to access

• Can bruise/hematoma

• Cosmetic concerns (bulging, aneurysm)

What is the key difference between AV graft and AV fistula?

• Graft: synthetic, faster use, more complications

• Fistula: natural, slower use, fewer complications ⭐

What is a dialysis catheter?

• Central line access

• Temporary or tunneled

What is the difference between temporary and tunneled catheter?

• Temporary: ≤14 days, NOT tunneled ⭐

• Tunneled: longer use, under skin, lower infection risk

Where are dialysis catheters commonly placed?

• Internal jugular (preferred) ⭐

• Femoral (high infection risk)

• Subclavian (least preferred)

What is special about dialysis catheters?

Dual lumen:

• Red = removes blood

• Blue = returns blood

What teaching is important for AV access care?

• Wash daily with soap and water ⭐

• Use clean cloth/towel

• Monitor for infection

What should NEVER be done on an access extremity?

• NO BP

• NO IV

• NO venipuncture ⭐

Why should pressure be avoided on access?

• Can ↓ blood flow → clotting → loss of access

What should be done before dialysis?

• Clean access (soap/water or CHG) ⭐

• Prepare supplies

• Ensure access is ready

What is priority after dialysis needle removal?

Hold manual pressure until bleeding stops ⭐

What must be assessed after dialysis?

• Thrill (palpate) ⭐

• Bruit (auscultate)

What does thrill feel like?

Buzzing/vibration (like a cat purring) ⭐

How long should dressing remain after dialysis?

Remove within ~8 hours

What should the nurse do if bleeding occurs at access site?

• Apply manual pressure ONLY ⭐

• Avoid tight pressure dressings

How should dialysis catheters be handled?

• Treat as central line ⭐

• Keep capped and clamped

• Maintain sterile dressing

Why must catheter remain clamped and capped?

• Prevent air embolism ⭐

• Prevent infection

• Prevent clotting

What electrolyte imbalances are common in dialysis?

• Potassium

• Calcium
  → risk for dysrhythmias ⭐

What fluid complication occurs after dialysis?

Hypotension (too much fluid removed) ⭐

Why are dialysis patients at risk for anemia?

• ↓ RBC production (kidney failure)

• Blood loss during treatment

What is dialysis disequilibrium syndrome?

• Rapid shift of BUN → cerebral edema

• S/S:

  • Headache

  • Confusion ⭐

What is a sign of air embolism?

• SOB

• Confusion

What causes muscle cramps in dialysis?

Fluid/electrolyte shifts

Who is responsible for dialysis treatment?

Dialysis nurse

What is the bedside nurse responsible for?

• Medications

• Patient care

• Monitoring

• Communication ⭐

Why must the bedside nurse remain available?

Dialysis nurse may need assistance quickly

What are the most important priorities for dialysis access care?

• Protect access (NO BP/IV) ⭐

• Assess thrill/bruit

• Monitor for bleeding

• Prevent infection

• Recognize complications

A nurse is caring for a client with an AV fistula. Which action is appropriate?

A. Measure BP in the same arm
B. Palpate for thrill
C. Apply tight pressure dressing
D. Use for IV fluids

Which finding indicates a complication of AV graft?

A. Strong thrill
B. Warm skin
C. Pain and decreased perfusion in hand
D. Visible access

C. Pain and decreased perfusion in hand

Rationale:

• Indicates steal syndrome ⭐

• Blood diverted away → ischemia

A nurse is assessing a dialysis catheter. Which finding requires immediate action?

A. Clamped and capped line
B. Dressing intact
C. Open unclamped catheter
D. No redness

C. Open unclamped catheter

Rationale:

• Risk for air embolism + infection ⭐

• Immediate emergency

A client returns from dialysis with BP 88/54. What is the priority interpretation?

A. Expected finding
B. Fluid overload
C. Hypotension from fluid removal
D. Infection

C. Hypotension from fluid removal

Rationale:

• Dialysis removes fluid → ↓ BP ⭐

Which patient is at highest risk for dialysis disequilibrium syndrome?

A. Stable outpatient dialysis
B. First dialysis treatment with high BUN
C. Patient with normal labs
D. Patient post-transplant

B. First dialysis treatment with high BUN

Rationale:

• Rapid BUN shift → cerebral edema ⭐

A nurse is caring for a client with a dialysis catheter. Which action is correct?

A. Use all ports for IV meds
B. Leave line unclamped
C. Maintain sterile dressing
D. Flush with tap water

C. Maintain sterile dressing

Rationale:

• Central line care ⭐

• Prevent infection

🧠 FINAL TIP

If you see dialysis access question:

👉 Fistula = BEST
👉 No BP/IV = ALWAYS correct
👉 Thrill = must be present
👉 Hypotension = common complication