Vascular Access Care
What is a Vascular Access?
A vascular access is necessary for dialysis. A vascular access allows blood to be taken from the body, circulated through the artificial kidney and then returned to the body. The access can be in the form of a fistula or graft or a catheter placed into a large vein. A fistula is created by a surgeon by suturing an opening in an artery to a smaller sized opening in a vein. A graft is a piece of artificial material connecting an artery to a vein. A fistula or graft is usually placed in the wrist or elbow area of one arm. A catheter or central venous catheter (CVC) is a large intravenous tube with two lumens that is placed by the surgeon into a large vein, usually in the neck.
Before and after each treatment, the nurse will check to make sure your child's access is working and will check for bleeding and infection. Wraps or Band-Aids" cover the needle sites after each treatment. The following information will help you care for your child's access.
When the Fistula or Graft is New
Have your child raise his / her arm slightly on 1 or 2 pillows until the swelling goes away. This may take a few days to several weeks. Call your child's surgeon or kidney doctor if he / she experiences pain. The surgeon will inform you about incision care. The dialysis staff may help you with this when your child comes in for dialysis.
Inform the dialysis staff if your child experiences loss of feeling or tingling in his / her fingertips, and / or if his / her fingertips feel very cold to the touch. Report any swelling, redness, tenderness, or drainage from the fistula / graft site.
Care of Your Child's Healed Fistula / Graft
Wash the graft / fistula daily with soap and water. When you enter the Dialysis Clinic, stop at the sink and wash the graft / fistula with soap and water before sitting in your chair.
Check the graft / fistula daily for a "buzzing or pulsing" sensation. Notify your child's doctor if this sensation disappears or changes.
Remove Band-Aids" or wraps 2-4 hours after dialysis and check for the "buzzing or pulsing".
Safety Tips
- Keep the extremity with the graft / fistula in it free of tight clothing, jewelry, shoulder bags and backpacks.
- No heavy lifting (over 25 pounds).
- Do not lie on the graft / fistula arm, or sleep with your arm bent.
- Do not let anyone draw blood, start IV's, give IM injections or take blood pressures in your graft/fistula arm. (Epogen" can be injected, since it is given in the tissue).
- If bleeding starts after leaving dialysis, apply direct pressure to the bleeding site for 10 minutes. After 10 minutes, check the site.
- If bleeding continues to be strong, continue applying pressure and have someone call the nephrology office, dialysis unit, or doctor on call.
Tourniquet Exercises (for fistulas only)
The purpose of tourniquet exercises is to help your child's veins enlarge after the blood vessels have been sewn together to form a fistula. These exercises help the fistula function better for your dialysis treatment. Ask your physician or nurse the appropriate time to start the exercises after the surgery.
Put the tourniquet on your upper arm, above the fistula.
Tighten the tourniquet until it feels very snug but not painful.
Let your arm hang down to your side during the whole time you wear the tourniquet. Never leave the tourniquet on longer than 15 minutes. Your goal is to wear the tourniquet at least 4 times a day. Continue doing these exercises as long as you have a fistula. Do not do these exercises after your fistula arm has had needles inserted. Restart exercises the next day after dialysis.
Care of Your Child's Central Venous Catheter (CVC)
Your child's central venous catheter will come out of the upper part of his / her chest. This is called the "exit" site and must be kept clean and dry. The exit site will be covered with a dressing. The dialysis nurse will inspect the exit site and change the dressing at regular intervals. Your child will not be able to swim or take a bath.
What kind of access is needed for Peritoneal Dialysis?
A soft plastic catheter is placed into the abdominal cavity by the surgeon. This catheter will exit the abdominal wall just to the left or right of your umbilicus (belly button). The catheter will have a cap over the end to prevent leakage. Your dialysis nurse will teach you how to clean the site where the catheter exits the abdominal wall (exit site) and how to change the dressing. Your nurse will also teach you how to do the dialysis procedure at home.
Dialysis Unit: 513-636-4443, Mon., Wed., Fri. 7 am - 5:30 pm
Nephrology: 513-636-4531, 8:30 am - 5 pm
Hospital Operator: 513-636-4200. Request to speak to the Nephrologist on call.
Terms
- Dialysis
- Process used to maintain the chemical and fluid balance of the body when the kidneys have failed. Toxins, waste products and excess fluid are filtered out of the body.
- Hemodialysis
- The type of dialysis that involves using an artificial kidney machine.
- Peritoneal dialysis
- The type of dialysis that is done at home using the abdominal cavity.
- IM
- Intramuscular; directly into the muscle.
- Nephrology
- The study of the kidneys.
Contact Us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
Rev. 12/05
