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OR Nurse:
doi: 10.1097/01.ORN.0000410624.85839.2a
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Vascular access devices for hemodialysis

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INSTRUCTIONS Vascular access devices for hemodialysis

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Vascular access devices for hemodialysis

GENERAL PURPOSE: To provide the registered nurse (RN) with an overview of the access devices available for hemodialysis, and the differences among them. LEARNING OBJECTIVES: After reading this article and taking this test, you will be able to: 1. Identify the different access devices available for hemodialysis. 2. Explain the advantages and disadvantages among these access devices. 3. Discuss implications for nursing interventions for patients with vascular access devices.

1. The preferred long-term vascular access device (VAD) is an/a

a. AV graft.

b. CVC.

c. AV fistula.

d. AV shunt.

2. The type of vascular access used is mostly influenced by the

a. physician's preference.

b. course of the patient's kidney disease.

c. number of hemodialysis treatments required each week.

d. need to leave the dominant hand unencumbered.

3. An AV fistula takes approximately how long to mature?

a. 1 week.

b. 2 weeks.

c. 2.5 to 3 weeks.

d. 4 to 16 weeks.

4. AV fistulas have a clinical history of

a. lower complication rates than other devices.

b. being easily removed when complications arise.

c. preventing enlargement of the veins.

d. providing a more direct access to the kidneys.

5. A chief advantage of AV fistulas is that they

a. can be created for emergency use.

b. cause the veins to grow larger for easier access to the blood system.

c. can be used immediately after surgery.

d. use an artificial vein.

6. Creating an AV fistula requires the surgeon to

a. insert a synthetic access device directly into the vein.

b. connect an artery directly to a vein.

c. place a mesh around the vein to prevent enlargement.

d. suture a catheter to the vein.

7. AV grafts require the surgeon to

a. use an artificial vessel to join artery and vein.

b. connect an artery directly to a vein.

c. use a vein from the patient's leg to connect the artery and vein.

d. place the graft as near to the kidney as possible.

8. Which of the following statements about VADs is correct?

a. AV grafts have fewer complications than other VADs.

b. An AV shunt is the most frequently used temporary VAD.

c. An AV graft has a faster maturation time than an AV fistula.

d. The risk of thrombosis is minimal with an AV graft.

9. A CVC for hemodialysis

a. is recommended for permanent access.

b. has less risk of complications than other devices.

c. is always placed in the subclavian vein.

d. is used for temporary vascular access when immediate hemodialysis is needed.

10. Stenosis of an AV fistula may require

a. stent placement.

b. flushing with a 0.9% sodium chloride solution prior to hemodialysis.

c. flushing with a fibrinolytic agent.

d. angioplasty.

11. Infection control requires that access sites be cleaned

a. three times a day.

b. daily.

c. two times a week.

d. weekly.

12. The most common problem experienced with VADs is

a. infection.

b. stenosis.

c. blood seepage around the device.

d. thrombosis.

13. After an AV fistula procedure, the patient should be taught

a. to keep the operative arm bent at a 45-degree angle for the first 24 hours.

b. that decreased sensation in the operative arm is expected after surgery.

c. that BP measurements aren't permitted in the operative arm.

d. to place the operative arm in a sling at night for protection during sleep.

14. After placement of an access device, the RN should assess patency

a. every 30 minutes x 2 then every hour.

b. every 15 minutes x 8, then every 2 hours.

c. once an hour for 6 hours.

d. once an hour x 2, then every 3 hours x 4.

15. Bruit in a fistula or graft is assessed by

a. palpation for a buzzing sensation.

b. visualization of pulsations.

c. auscultation with a stethoscope.

d. palpation for turbulent blood flow.

16. The first 2 hours after placement of a fistula, the patient's arm should be

a. kept dependent.

b. placed in a sling.

c. bent at a 45-degree angle.

d. kept straight.

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