Checking the Patency of an AV Fistula

AV (arteriovenous) fistulas are used to deliver dialysis to kidney patients. They open a port between an artery and vein, usually placed in the wrist or near the elbow. The dialysis machine connects to the fistula removing wastes from the blood that the kidneys failed to remove. Keeping an AV fistula cleared is very important for the health of the patient. Nursing staff members observe the fistula for any complications, and patients are educated on signs that indicate problems with the device. Hospitals develop their own protocols for checking the patency of an AV fistula.

Things You'll Need

• BP cuff (sphygmomanometer)
• Stethoscope
• Bolus medication

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Instructions

• 1

  Check with the surgeon when the patient arrives from the operating room what the acceptable systolic BP is for the patient. Check the bruit (audible sound of the shunt) and the thrill (pulsation of the shunt). University of North Carolina Hospitals' nursing care for AV fistulas is cited in the following steps.

• 2

  Listen for bruit over the fistula with a stethoscope and palpate for thrill every 30 minutes for the first hour. Continue every hour as recommended by doctor's orders. Palpating for thrill will determine the pulsation of the shunt. Feel lightly over the distal shunt or a central vein closer to the heart.

• 3

  Assess the shunt every 30 minutes for the first hour and then every hour per orders, also upon discharge. Assessment should include any change in temperature, sensation, color and movement. Check for the presence of swelling, bleeding at the incision and good capillary refill. Record the distal pulse and any changes.

• 4

  Maintain patency by administering fluids bloused through the shunt. Saline solution and pharmacologic treatments will maintain an adequate blood flow and keep the shunt clear of any thrombosis (blood clotting).

• 5

  Continue treatment until the patient is released by observing the operative site and keeping it elevated. Rest the extremity on a pillow to avoid edema (swelling). Keep the arm straight and avoid bending to prevent vessel constriction.

• 6

  Instruct patients concerning the care of the AV fistula. These instructions include checking the blood flow and pulse to assure adequate patency, not allow blood pressure measurement to be taken in the arm, avoiding bumping the operative site on objects, avoiding tight clothing or jewelry on that arm, sleeping with the arm free of constriction and avoiding lifting heavy objects.