Page 1844 - Saunders Comprehensive Review For NCLEX-RN

increased blood flow in the venous
system.

Arterial steal syndrome can develop in a

client with an internal arteriovenous fistula. In this
complication, too much blood is diverted to the vein,
and arterial perfusion to the hand is compromised.
D. Internal arteriovenous graft (see Fig. 54-2)
1. Description
a. The internal graft may be used for
chronic dialysis clients who do not
have adequate blood vessels for the
creation of a fistula.
b. An artificial graft made of Gore-Tex or
a bovine (cow) carotid artery is used to
create an artificial vein for blood flow.
c. The procedure involves the anastomosis
of an artery to a vein, using an artificial
graft.
d. The graft can be used 2 weeks after
insertion.
e. Complications of the graft include
clotting, aneurysms, and infection.
2. Advantages and disadvantages: Same as for internal
arteriovenous fistula

E. Interventions for an arteriovenous fistula and

arteriovenous graft
1. Teach the client that the extremity should not be used
for monitoring BP, drawing blood, placing IV lines, or
administering injections, and that the client should
inform all health care personnel of its presence.
2. Teach the client with an arteriovenous fistula to
perform hand-flexing exercises such as ball squeezing
(if prescribed) to promote graft maturity.
3. Note the temperature and capillary refill of the
extremity.
4. Palpate pulses below the fistula or graft, and monitor
for hand swelling as an indication of ischemia.
5. Monitor for clotting.
a. Complaints of tingling or discomfort in
the extremity
b. Inability to palpate a thrill or auscultate
a bruit over the fistula or graft
6. Monitor for arterial steal syndrome.
7. Monitor for infection.
8. Monitor lung and heart sounds for signs of heart

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