1. Nursing Instruction
  2. Overview
  3. Nephrology
【Major points】
  1. Keeping your vascular access working well is essential for good dialysis quality.
  2. If your overall condition allows, an arteriovenous fistula (AVF) is recommended as the first choice for hemodialysis access.
  3. You should check your central venous catheter or assess your fistula function every day.
 
What is vascular access for hemodialysis?

  • Vascular access for hemodialysis refers to a created vascular pathway that allows a uremic patient to receive hemodialysis treatment. A well-functioning vascular access is essential for performing efficient hemodialysis.

  • Types of vascular access：Arteriovenous fistula(AVF)、Double-lumen tunnelled dialysis catheters 、Central venous catheter(CVC)

 Caring for vascular access
  1. Double-lumen tunnelled dialysis catheters or CVC
    1. Change the dressing every two days, or sooner if needed, to keep the site clean and dry.
    2. Check the catheter site for any signs of infection, such as discharge, redness, swelling, warmth, or pain. If you experience any discharge, fever, or signs of infection, please visit the nephrology clinic or emergency room promptly.
    3. Make sure the catheter is properly clamped when not in use. Avoid pulling or twisting the catheter. Keep it unobstructed.
      1. Use catheter tape to secure the catheter properly.
      2. Try to wear loose clothes to avoid pulling or kinking the catheter.
    4. When showering, avoid getting the wound and catheter wet. Clean the surrounding skin by wiping.    
  2. AVF
    1. Observe the fistula daily for signs of redness, swelling, warmth, pain, or other signs of infection. Palpate the fistula to check for a thrill and listen for a bruit (a swishing sound). If either is absent, the fistula may be occluded. Notify medical staff as soon as possible.
    2. Home care of arteriovenous fistulas includes arm movements, physical therapy, water and diet control, prevention of infections, and smoking cessation etc. In order to maintain the functions of fistulas, extend the service life and reduce the occurrence of obstruction.
    3. Based on the patient's condition and the physician’s professional judgment, far-infrared adjuvant therapy may be used to help maintain the patency of the AVF or AVG.
    4.  It is recommended to regularly undergo blood flow examinations for AVF and AVG.
 
Reference
  1. Arasu, R., Jegatheesan, D., & Sivakumaran, Y. (2022). Overview of hemodialysis access and assessment. Canadian Family Physician, 68(8), 577-582. https://doi.org/10.46747/cfp.6808577
  2. Chen, F. Y., Ho, Y., & Lin, C. C. (2021). KDOQI Clinical practice guidelines for vascular access:2019. Kidney and Dialysis, 33(2),97-100. https://doi.org/10.6340/KD.202106_33(2).0009
  3. Ou, S. H., &  Lee, P. T.(2021). Vascular Access Set-Up and Care Kidney and Dialysis. Kidney and Dialysis, 33(2), 63-67. https://doi.org/10.6340/KD.202106_33(2).0002
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    Location
    1. Nursing Instruction
    2. Overview
    3. Nephrology
    Category
    Self-care / Home Care
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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