Upon arrival to the clinic's waiting room, the patient will apply a warm, moist towel to the access arm
to moisten scabs for easier removal.
The patient extends the access arm
to the side horizontally, at or just below shoulder level, and rests it on the cushion.
The appearance of her access arm
changed only minimally from her baseline.
It is believed that we can achieve higher pump speeds if the needle is against the flow, but I have seen that this increases the risk of venous infiltration and the subsequent swelling and bruising of the access arm
. It is better to run with slower pump speeds initially to prevent infiltration and assist in the maturation of the AVE
Indications of vascular access decline are: cannulation problems, increasing venous pressure noted during dialysis, arterial inflow problems that necessitate decreasing blood flow rate, edema or swelling of the access arm
, increased hemostasis time or prolonged bleeding of the needle sites after dialysis, and a decrease in urea clearance as indicated by decreased PRU.