Vascular Access Care
General rules of fistula or graft care:
Keep the skin over the access clean
Avoid sleeping on the access arm
Protect arm from injury
Do not allow blood to be drawn, IVs to be inserted or blood pressure measurements to be taken on the access arm
Wear loose clothing and avoid jewelry over the access
General rules for catheter care:
Keep the dressing dry and intact
Do not use sharp instruments, such as scissors, near the catheter
Do not use the catheter for anything other than dialysis
Be careful not to snag the catheter on clothing or other objects - you can pull it out
General rules for your dialysis caregiver:
Wash his/her hands and change gloves before caring for you
Look, feel and listen to your access before every treatment
Always clean the skin over your access well before needle placement
Rotate needle placement sites to prevent breakdown of vessel or graft material
Check catheter exit site for signs and symptoms of infection prior to the start of your dialysis treatment
Wear a mask when opening your catheter caps (you should too!)
Teach you, when possible, to properly hold pressure to your access site when the needles are removed after your treatment
Access Self-Assessment
Your access allows you to receive life-saving dialysis treatments. Because of this, it is commonly referred to as your “life-line.” A well-functioning access is necessary to achieve maximum dialysis efficiency. When dialysis treatments become inefficient or inadequate, toxins build up in the body and can potentially affect your quality of life.
By paying attention to the health of your access and making sure problems with it get fixed right away, your access will last longer. Changes within your access are oftentimes subtle and take weeks, even months, to develop. Because of this, it is important to evaluate your access every day. You are in the best position to notice changes in your access, especially the small ones, long before they evolve into serious complications.
Patients that have adopted the “Look, Feel and Listen” process of physical assessment quickly realize how important frequent monitoring is. By following the three steps as outlined here, you can familiarize yourself with your access, how it works and how to properly care for it.
Step 1: Look
Inspect the skin over your access. Changes in skin color, swelling, redness or enlarging bumps are not normal. Allow scabs over previous cannulation sites to completely heal – do not disrupt them.
Step 2: Listen
Listening to your access and knowing the meaning of the sounds you hear can help you detect common complications. Position your ear over your access to hear the flow sound. You can also use a stethoscope for this exercise. Affordable stethoscopes can be purchased at a local medical uniform store or through a variety of online retailers.
When listening to a fistula or graft, you will hear a whooshing sound called a bruit (pronounced “broo-ee”). A normal bruit will be low-pitched and continuous. Begin listening at the incision line and move up the entire length of your access. The bruit should be strongest at the incision line and should gradually fade as you move up the access.
Step 3: Feel
Run your hand gently across your access. You will feel a distinct buzzing feeling known as a thrill. Starting at the incision line when the artery and vein are connected to form your access, run your hand across the entire length of the access. The thrill should be strongest at the incision line and should gradually fade as you move your hand up. If you have a fistula, it should feel soft and can be compressed easily. If you have a graft, it will feel firm and tube-like.
NOTE: A strong pulse in the fistula or graft without a gentle thrill is not normal.