Question

To prepare for hemodialysis, a client schedules his or her surgical procedure for an internal arteriovenous fistula in one arm and placement of an external arteriovenous shunt in the other arm. Which considerations would the nurse integrate into this client's postoperative plan of care?

1 The graft has a higher risk of hemorrhage, clotting, and infection than the fistula does.
2 Staff will obtain blood pressure readings from the arm with the fistula, but not the one with the shunt.
3 Administer intravenous (IV) fluids in the arm with the shunt, but not the one with the fistula.
4 Cover the fistula with a light dressing, and cover the shunt thoroughly with a heavy dressing.

Answer 1

The postoperative care for hemodialysis access sites includes monitoring for hemorrhage, clotting, and infection at the internal arteriovenous fistula site, avoiding taking blood pressure readings or administering IV fluids in the limb with the fistula or shunt, and dressing the sites appropriately to prevent complications.

Step-by-step explanation:

The postoperative care for a patient who has had a surgical procedure for an internal arteriovenous fistula and placement of an external arteriovenous shunt requires careful consideration to prevent complications. Hemodialysis requires frequent access to the bloodstream, hence the need for these procedures. When providing care:

• The graft associated with the fistula is at a higher risk of hemorrhage, clotting, and infection compared to the shunt, so monitoring for signs of these complications is essential.
• Blood pressure readings should be taken from the arm without the fistula or the shunt to avoid damage or inaccurate readings.
• IV fluids should also be administered in an extremity without these devices to prevent complications.
• The fistula should generally be covered with a light dressing to allow for monitoring and minimize infection risk, whereas shunt dressings may need to be more secure to prevent dislodgement and bleeding.

It is important to follow the surgeon's specific instructions for dressing and monitoring both the fistula and the shunt to ensure proper healing and functionality for successful hemodialysis treatment.