Medical Surgical Dialysis #6

Question

A client with a diagnosis of chronic renal failure who also receives hemodialysis is in the renal clinic for follow-up. The clinic nurse will perform which action to ensure patency of the arteriovenous (AV) fistula used for dialysis? Select all that apply.

Answers

  1. Palpate both radial pulses to determine if they are beating together.
    • Rationale:

      This answer is not correct because this action is implemented to assess blood flow differences between the upper extremities; however, this action does not ensure patency of the AV fistula used for hemodialysis.

  2. Palpation of thrill over the fistula.
    • Rationale:

      This answer is correct because blood flow through the AV fistula can be assessed by palpation at the site. A thrill or vibration, will be felt with adequate blood flow.

  3. Absence of bruit to the fistula.
    • Rationale:

      This answer is not correct because a bruit is the sound that is heard when the AV fistula is auscultated with a stethoscope and is indicative of blood flow. The lack of a bruit is indicative of a blockage.

  4. Observe for Trousseau’s sign.
    • Rationale:

      This answer is not correct because trousseau’s sign is carpopedal spasm caused by inflating the blood-pressure cuff to a level above systolic pressure for 3 minutes and is indicative of hypocalcemia.

  5. Check the client's circulation distally to the vascular access.
    • Rationale:

      This answer is correct because checking the client’s circulation by palpating his distal pulses ensures adequate blood is flowing. The nurse can also check circulation by observing capillary refill in the client’s fingers and assessing for altered sensation or pallor.

Overview

Hemodialysis is a medical procedure to remove fluid and waste products from the blood and to correct electrolyte imbalances. An AV fistula is a connection that is made between an artery and a vein for dialysis access.

Explanation

Learning Outcomes

An AV fistula is a connection that is made between an artery and a vein for dialysis access. It allows blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter, called a dialyzer. The rumbling or swooshing sound of a dialysis fistula bruit is caused by the high-pressure flow of blood through the fistula. Although the bruit sound is heard with a stethoscope, it also can be palpated over the fistula as a thrill (i.e., vibration).

Test Taking Tip

Consider whether each choice is indicative of a functional AV fistula to answer this question correctly.

Video Rationale