B Y : M R . J . G S A M B A D , S Y . M S C N U R S I N G - N E P H R O U R O L O G Y
AV (Arteriovenous) grafts are much like fistulas in most respects, except
that an artificial vessel is used to join the artery and vein.
The graft usually is made of a synthetic material, often PTFE
(Polytetrafluoroethylene).Grafts are inserted when the patient's native
vasculature does not permit a fistula.
They mature faster than fistulas, and may be ready for use several weeks
after formation (some newer grafts may be used even sooner).
To create a graft, the surgeon makes an incision in the patient's forearm,
upper arm, or thigh. He then tunnels a natural or synthetic graft under the
skin and sutures the distal end to an artery and the proximal end to a vein.
The main indication of the AV GRAT is Hemodialysis.
- Congestive heart failure
The AV graft provides a solution for small or weak veins.
The AV graft can be used as soon as 2-4 weeks after placement.
AV graft surgery is usually done on an outpatient basis, under local
anesthetic, allowing for a rapid and easy recovery.
– Use of synthetic material in the body.
– With AV graft there is an increased risk of blood clotting, aneurysms
– Repeated blood clots can block the flow of blood through the graft.
– AV graft tends to close more quickly than the fistula.
– AV graft needs constant attention and upkeep.
– AV graft does not last as long as a fistula and will probably need to be
A PATIENT IN END-STAGE kidney disease relies on dialysis to
mechanically remove fluid, electrolytes, and waste products from the
For the most effective hemodialysis, the patient needs good vascular
access with an AV graft that provides adequate blood flow. Follow
policies and procedures and these clinical tips to protect and preserve
the vascular access and avoid complications such as infection, stenosis,
thrombosis, and hemorrhage:
1. Remove any restrictive clothing or jewelry from the arm.
2. To prevent injuries, place an armband on the patient or a sign over the
bed that says no BP measurements, venipunctures, or injections on
the affected side. When blood flow through the vascular access is
reduced, it can clot.
3. Perform hand hygiene before you assess or touch the vascular access.
If it's a new vascular access with a wound, don gloves. Position the
patient's arm so the vascular access is easily visualized.
4. Assess for patency at least every 8 hours.
5. Palpate the vascular access to feel for a thrill or vibration that
indicates arterial and venous blood flow and patency.
6. Auscultate the vascular access with a stethoscope to detect a bruit or
"swishing" sound that indicates patency.
7. Check the patient's circulation by palpating his pulses distal to the
vascular access; observing capillary refill in his fingers; and assessing
for numbness, tingling, altered sensation, coldness, and pallor in the
8. Notify the healthcare provider promptly if suspect clotting.
9. Assess the vascular access for signs and symptoms of infection such as
redness, warmth, tenderness, purulent drainage, open sores, or
swelling. Patients with end-stage kidney disease are at increased risk
10. After dialysis, assess the vascular access for any bleeding or
11. When move the patient or help with ambulation, avoid trauma to or
excessive pressure on the affected arm.
12. Assess for blebs (ballooning or bulging) of the vascular access that
may indicate an aneurysm that can rupture and cause hemorrhage.
13. Monitor serum electrolytes, blood urea nitrogen, creatinine, and
hemoglobin and hematocrit levels before and after dialysis. Monitor
fluid status. Monitor coagulation studies because heparin is used to
prevent clotting during dialysis.
14.Teach the patient
To make sure that dialysis needle stick locations are rotated to prevent
stenosis and thrombus formation
To check the function of the vascular access several times a day by
palpating it and feeling for vibration
To monitor for any bleeding after dialysis
To monitor for signs of infection
To keep the site clean
To avoid wearing any clothing or jewelry that restricts the access and to
prevent any one from using the extremity to obtain BP or perform
Not to use the arm with vascular access to carry heavy objects and not
to sleep on the arm
Not to use any creams and lotions on the vascular access site.
15. Document assessment findings, any interventions and patient
responses, patient teaching, and the patient's level of understanding.
Arterial steal syndrome is caused by the graft diverting too much blood
into the vein. The hand then does not receive enough of a blood supply.
The signs and symptoms of steal syndrome are coldness in the hand/
fingers. This will be monitored.
Thrombosis may be common cause of graft failure but this type of clot is
not life threatening.
Infection is a risk with a graft.
Pseudo aneurysm is a rare complication of arteriovenous-grafts (AVGs)
used in hemodialysis patients. Rupture and bleeding are the most