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Arteriovenous graft

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This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.

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Arteriovenous graft

  1. 1. 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 ARTERIOVENOUS GRAFT
  2. 2. Introduction  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).
  3. 3. Definition  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.
  4. 4. Indication  The main indication of the AV GRAT is Hemodialysis.  Contraindication: - Congestive heart failure - Infection - Burns - Thrombosis
  5. 5. Advantages  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.
  6. 6. Disadvantages – Use of synthetic material in the body. – With AV graft there is an increased risk of blood clotting, aneurysms and infections. – 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 replaced eventually.
  7. 7. Nursing care  A PATIENT IN END-STAGE kidney disease relies on dialysis to mechanically remove fluid, electrolytes, and waste products from the blood.  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:
  8. 8. Cont.. 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.
  9. 9. Cont.… 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 affected extremity. 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 of infection.
  10. 10. Cont.. 10. After dialysis, assess the vascular access for any bleeding or hemorrhage. 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.
  11. 11. 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 venipuncture
  12. 12. Cont..  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.
  13. 13. Complication  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 common complications
  14. 14. THANK YOU…….

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