Caring for a Hemodialysis Access (Arteriovenous Fistula or Graft)

Goal: The graft or fistula remains patent; the patient verbalizes appropriate care measures and observations to be made, and demonstrates care measures.

1. Perform hand hygiene and put on PPE, if indicated.

2. Identify the patient.

3. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do, and why you are going to do it, to the patient.

4. Inspect area over access site for any redness, warmth, tenderness, or blemishes. Palpate over access site, feeling for a thrill or vibration. Palpate pulses distal to the site. Auscultate over access site with bell of stethoscope, listening for a bruit or vibration.

5. Ensure that a sign is placed over head of bed informing the healthcare team which arm is affected. Do not measure blood pressure, perform a venipuncture, or start an IV on the access arm.

6. Instruct the patient not to sleep with the arm with the access site under head or body.

7. Instruct patient not to lift heavy objects with, or put pressure on, the arm with the access site. Advise the patient not to carry heavy bags (including purses) on the shoulder of that arm.

8. Remove PPE, if used. Perform hand hygiene.