Arteriovenous Fistula Care
AV Fistula Care
After AV fistula insertion, the nurse should keep in mind to perform the following: (A-B-C-D)
A – Assess the fistula regularly for patency
B – Begin to examine the surrounding skins for signs of infection
C – Cleaning the venous and arterial sites
D – Dressing the site with sterile bandages
When these procedures are done before a dialysis, the life of the fistula is prolonged, infection can be prevented and early detection of clotting is made possible.
AV Fistula Care: Equipments
- Sterile gloves
- Sterile 4” by 4” gauze pads
- Sterile cotton strips applicators
- Antiseptic solution
- Bulldog clamps
- Hypoallergenic tape
Key Steps of AV Fistula Care
- Confirm patient identity.
- Explain the procedure to the patient to gain cooperation. Provide privacy by draping the patient and wash your hands.
- On a stable surface, place the drape and position patient’s hand on the draped surface. The rationale for doing this is to reduce the risk of traumatic injury to the fistula.
- Remove the bulldog clamps from the elastic bandage and unwrap the bandage in the fistula or graft site.
- Carefully remove the gauze dressing covering the shunt and the 4” x 4” dressing under the fistula or graft.
- Indications of possible infection should be assessed. Arterial and venous exit sites should be carefully evaluated for erythema, swelling, excessive tenderness and drainage.
- Blood flow in the fistula should be checked. This is done by inspecting the color of blood and comparing the warmth of the fistula with that of the surrounding skin. Normal findings: blood should be bright red and the fistula should be warm as the skin. Notify the physician immediately for abnormal findings.
- To check the blood flow, auscultate the fistula between the exit sites. A bruit confirms a normal blood flow.
- Lightly place your finger over the access site and palpate for vibration. Feeling thrill on palpation also confirms normal blood flow.
- Don gloves after soaking the 4” x 4” sterile gauze pads and cotton-tipped applicators in the antiseptic solution.
- Clean the site using the soaked gauze pad wiping from the site outwards. Crusted materials from the exit sites are removed using cotton-tipped applicators.
- Do the same with the other site.
- Antimicrobial ointment should be applied, if prescribed to help prevent infection.
- Cover the exit sites with a dry 4” x 4” gauze pad and secure it using a hypoallergenic tape.