衛教資訊
Instructions for hemodialysis vascular access 洗腎血管通路照護須知
Instructions for hemodialysis vascular access 洗腎血管通路照護須知
The most common source of infection in patients with uremia comes from vascular access. In patients receiving long-term hemodialysis, the most common causes of hospitalization are vascular access related complications including partial or complete access stenosis or obstruction. Vascular access has a limited longevity, with survival rates between 1.5 and 2 years in average.
Vascular access care should begin as soon as the patient is admitted to the hospital. These patients who may need long-term hemodialysis should immediately determine which limb will undergo vascular surgery and avoid the treatment and blood withdrawal of the limb.
Care and precaution of arteriovenous fistula
Avoid compression
- Start to exercise your fistula arm 2 to 7 days after surgery.
- Avoid heavy lifting or carrying heavy loads with your fistula arm
- Avoid sleeping on your arm in which vascular access is created
- Do not wear watch or accessory on your fistula arm
- Do not take blood pressure measurements, have any blood tests taken, or receive needles or infusions from your fistula arm
- Do not wear any tight or restrictive clothing on your fistula arm
Prevention of infection
- Thoroughly clean and sanitize your fistula arm before hemodialysis.
- Avoid scratching the fistula arm. If you develop pain, redness, or the skin around your fistula becomes hot, please tell your nurse or doctor immediately.
- Avoid bathing if the wound is not healed or after dialysis. When bathing, you must be careful not to get wet at the puncture wound.
- If the dressing gauze is wet, contaminated, or blood-stained, the puncture wound must be re-dressed with new gauzes and tapes.
- The gauze covering the puncture wound must be removed the next day to dry the wound.
- If there are signs of infection such as redness, swelling, heat and pain in the puncture wound, you should seek medical treatment immediately.
- Self-check for symptoms of infection
Signs of stenosis
- You cannot feel a vibration (‘thrill’) when checking fistula.
- There is mild pain or the blood vessels have a hard touch which hard to the touch, which is a little different than usual.
- Once the signs of vascular obstruction are found, please contact the staff for further examination and treatment by cardiologist or cardiovascular surgeon.
How to Check
- Place your fingers on the skin over your fistula; you should feel a vibration (‘thrill’). Listen for the ‘shoosh-shoosh’ noise (‘bruit’) made by your fistula. You should check once a day that your fistula is working.
- Signs of stenosis: you cannot feel thrill or listen for bruit.
- 呂淑卿、李碧霞、謝湘俐、莊宇慧(2017).血液透析患者動靜脈瘻管阻塞原因及預防與居家照護.臺灣腎臟護理學會雜誌,16(3),1-12。https://doi.org/10.3966/172674042017091603001
- 陳盈安、楊五常、林志慶(2015).慢性腎臟病患者的透析血管通路建立時機及術前評估.腎臟與透析,27(1),6-9。https://doi.org/10.6340/KD.2015.27(1).02
- Costa Pessoa, N. R., de Souza Soares Lima, L. H., Dos Santos, G. A., de Queiroz Frazão, C. M. F., Sousa, C. N., & Ramos, V. P. (2020). Self-care actions for the maintenance of the arteriovenous fistula: An integrative review. International journal of nursing sciences, 7(3), 369–377. https://doi.org/10.1016/j.ijnss.2020.06.007
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