We are pleased to bring you a brand-new blog series from Best Care. Our Qualified Professional (QP) staff are compiling useful information and practical advice for caregivers and recipients of care.
Let’s start with a breakdown of dialysis access care with Dawn Diatta, MSN, RN.
What You Need to Know About Dialysis Access Care
It is important for dialysis patients to take care of their dialysis access. The dialysis access is the dialysis patient’s lifeline. These simple steps to care for the access at-home can improve the longevity of the access and decrease visits to vascular physicians and surgeons.
There are basically two types of dialysis access:
This is an “arteriovenous fistula” or an “arteriovenous graft.” Take care to ensure no constant, excessive pressure is placed on the internal access, as this can result in clotting the access. The patient can avoid this pressure by trying not to sleep on the side where the access is placed.
Be sure to remove the post-dialysis bandage before you go to bed that same day. It is a pressure dressing. Do not let it remain on your access for over 24 hours.
Most internal access are in the arms. There are some cases where the access might be in the leg. When the internal access is in the arm, do not allow blood pressures or blood draws to be taken from the arm in which there is the dialysis access. This can damage the access. People receiving dialysis will often wear a bracelet on their access arm as a reminder to themselves and healthcare workers to avoid procedures on that arm.
Common Cares for Dialysis Access
A significant concern for dialysis patients is that their internal access will begin to bleed when they are at home.
If this does happen, do not panic. Simply grab some clean gauze, or a nearby cloth, and apply pressure to the access. Apply pressure for at least 15 minutes.
When the bleeding has ceased, dress the site with gauze and tape. Should it not stop after 15 minutes, continue to hold pressure. If the site continues to bleed after 45 minutes, go to the emergency department to receive a stitch to close the site. The patient can then report to dialysis as normal.
The external access is a central venous catheter (CVC). There will be a dressing placed on the catheter when the catheter is placed. It is imperative to keep this dressing dry. It will be changed at dialysis – and only at dialysis as it is a clean procedure. With the external catheter, you cannot swim and showers are discouraged. It is highly recommended that the patient finds another way to bathe.
Should you have to shower, ensure there is a waterproof covering over the external access. This access ends directly in the heart. Infection is of concern with a CVC for this reason. They carry a higher risk of infection than internal access.
Should a bandage come off when you are at home, cover the site with sterile gauze by placing tape around the edges of the gauze.
On rare occasions, an external catheter can fall out.
If this does happen, apply pressure to the site for 20 minutes. There should be minimal bleeding. Contact your dialysis facility and report that your catheter has fallen out. They will want to know before your next dialysis so that a new access can be placed before the next treatment.
Sometimes, the CVC can get pulled and still be inside, yet hanging further down from the exit site than before. Should that happen, secure the end with a piece of tape and contact your dialysis facility for further instructions. They may want you to have the CVC replaced.
These simple tasks can give your lifeline a longer life.
No matter what you read or are told, when in doubt, always contact your dialysis facility with any questions regarding your access. They want to maintain the patency and longevity, as well.