Page 1842 - Saunders Comprehensive Review For NCLEX-RN

b. Risk of hemorrhage, infection, or
clotting
c. Potential for skin erosion around the
catheter site

4. Interventions

a. Avoid getting the shunt wet.
b. Wrap a dressing completely around the
shunt and keep it dry and intact.
c. Keep cannula clamps at the client’s
bedside or attached to the
arteriovenous dressing for use in case
of accidental disconnection.
d. Teach the client that the shunt
extremity should not be used for
monitoring BP, drawing blood, placing
IV lines, or administering injections.
e. Fold back the dressing to expose the
shunt tubing and assess for signs of
hemorrhage, infection, or clotting.
f. Monitor skin integrity around the
insertion site.
g. Auscultate for a bruit and palpate for a
thrill, although a bruit may not be
heard with the shunt.
h. Notify the PHCP immediately if signs
of clotting, hemorrhage, or infection
occur.

5. Signs of clotting

a. Fibrin: White flecks in the tubing
b. Separation of serum and cells
c. Absence of a previously heard bruit;
thrill absent on palpation
d. Coolness of the tubing or extremity
e. Tingling sensation at site or in extremity
C. Internal arteriovenous fistula (see Fig. 54-2)
1. Description
a. A permanent access of choice for the
client with CKD requiring dialysis.
b. The fistula is created surgically by
anastomosis of a large artery and large
vein in the arm.
c. The flow of arterial blood into the
venous system causes the vein to
become engorged (matured or
developed).

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