Post on 09-Apr-2018
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ACCESS FOR HEMODIALYSISACCESS FOR HEMODIALYSIS
SUBCLAVIAN AND FEMORAL CATHETERSUBCLAVIAN AND FEMORAL CATHETER
EXTERNAL ARTERIOVENOUS SHUNT EXTERNAL ARTERIOVENOUS SHUNT
INTERNAL ARTERIOVENOUS FISTULAINTERNAL ARTERIOVENOUS FISTULA
INTERNAL ARTERIOVENOUS GRAFT INTERNAL ARTERIOVENOUS GRAFT
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SUBCLAVIAN VEIN CATHETER SUBCLAVIAN VEIN CATHETER
The catheter may be left in place for The catheter may be left in place for
up to 6 weeks if complications do notup to 6 weeks if complications do not
occur. It is usually filled with heparinoccur. It is usually filled with heparinand capped to maintain patencyand capped to maintain patency
between dialysis treatments between dialysis treatments..
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F EMORAL VEIN CATHETER F EMORAL VEIN CATHETER
The client should not sit up moreThe client should not sit up more
than 45 degrees or lean forward.than 45 degrees or lean forward.
Assess the extremity for circulationAssess the extremity for circulation,temperature, and pulses.,temperature, and pulses.
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EXTERNAL ARTERIOVENOUS SHUNT EXTERNAL ARTERIOVENOUS SHUNT
Access is formed by the surgical insertion of Access is formed by the surgical insertion of
two Silastic cannulas into an artery and vein intwo Silastic cannulas into an artery and vein in
the leg or forearm to form an external bloodthe leg or forearm to form an external blood path. The cannulas are connected to form a U path. The cannulas are connected to form a U
shape; blood flows from the clients arteryshape; blood flows from the clients artery
through the shunt into the vein.through the shunt into the vein.
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ADVANTAGESADVANTAGES
The external arteriovenous shunt can be usedThe external arteriovenous shunt can be used
immediately.immediately.
No venipuncture is necessary for dialysis. No venipuncture is necessary for dialysis.DISADVANTAGESDISADVANTAGES
External danger of disconnecting or dislodgingExternal danger of disconnecting or dislodging
the shunt exists.the shunt exists. Risk of hemorrhage, infection or clottingRisk of hemorrhage, infection or clotting
exists.exists.
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INTERNAL ARTERIOVENOUS F ISTULA INTERNAL ARTERIOVENOUS F ISTULA
Provides the access of choice Provides the access of choice
for chronic dialy sis clients. Itfor chronic dialy sis clients. It
is created surgically by is created surgically by anastomosis of a large arter y anastomosis of a large arter y
and large vein in the arm.and large vein in the arm.
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ADVANTAGESADVANTAGES
The danger of clotting and bleeding is less.The danger of clotting and bleeding is less. The fistula can be used indefinitely.The fistula can be used indefinitely.
No external dressing is required. No external dressing is required.
Allows freedom of movement.Allows freedom of movement.DISADVANTAGESDISADVANTAGES
It cannot be used immediately after insertion.It cannot be used immediately after insertion.
Needle insertion are required for dialysis. Needle insertion are required for dialysis.
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INTERNAL ARTERIOVENOUS GRA F T INTERNAL ARTERIOVENOUS GRA F T
It is used primarily for chronic dialysisIt is used primarily for chronic dialysisclients who do not have adequate bloodclients who do not have adequate blood
vessels for the creation of a fistula. Thevessels for the creation of a fistula. The
procedure involves the anastomosis of the procedure involves the anastomosis of thegraft to the artery, a tunneling under thegraft to the artery, a tunneling under the
skin and anastomosis of a vein. This graftskin and anastomosis of a vein. This graft
can be used 2weeks after insertion.can be used 2weeks after insertion.
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TYPES O F PERITONEAL DIALYSIS TYPES O F PERITONEAL DIALYSIS
Continuous ambulatory peritoneal dialysisContinuous ambulatory peritoneal dialysis
does not require a machine for thedoes not require a machine for theprocedure, it promotes clientprocedure, it promotes clientindependence. The client performs self independence. The client performs self
dialysis 24 hours a day,7 days a week.dialysis 24 hours a day,7 days a week.The dialysis bag attached to the catheter,The dialysis bag attached to the catheter,is folded and carried under the clientsis folded and carried under the clientsclothing until time outflow. After dwell theclothing until time outflow. After dwell the
bag is placed lower than the insertion sitebag is placed lower than the insertion siteso that fluid drains by gravity flow andso that fluid drains by gravity flow andwhen full,the bag is changed and thewhen full,the bag is changed and theprocess is continue.process is continue.
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AUTOMATED PERITONEAL DIALYSIS AUTOMATED PERITONEAL DIALYSIS
It is similar to CAPD in that it is continuousIt is similar to CAPD in that it is continuousdialysis process.dialysis process.
It requires a peritoneal cycling machineIt requires a peritoneal cycling machine
Automated dialysis can be done as intermittentAutomated dialysis can be done as intermittent peritoneal dialysis, continuous cycling peritoneal dialysis, continuous cycling
peritoneal dialysis, or nightly peritoneal peritoneal dialysis, or nightly peritoneal
dialysis.dialysis.