Emergency Management of the Hi-Tech Patient in Acute and Critical Care. Группа авторов

Photo credit Xenia Morgan.)

      Arterio‐venous Access

       Decreased or absent thrill: Patients will typically be familiar with the location and quality of the thrill at their access site. They will have been instructed on assessing it daily. If a patient presents with concern for a decreased or absent thrill at their site, assessment by Doppler ultrasound and rapid communication with the renal and/or dialysis team is appropriate. Delay in treatment may lead to worse outcomes for the access site.

       Swelling or discoloration surrounding access: This may indicate thrombosis or infection. Any evidence of discoloration, induration, swelling, pain, or warmth should be discussed with the renal and/or dialysis team. Peripheral cultures and Doppler ultrasound are often appropriate. Recall that lab draws may be inaccurate for up to four hours after a dialysis session.

Consultation

      All forms of hemodialysis access are best managed by, or in consultation with, a patient or institution's own renal or dialysis experts. Early communication with these teams will reduce complications and morbidity for these patients.

Further Reading

      1 1 National Kidney Foundation (2001a). K/DOQI clinical practice guidelines for hemodialysis adequacy, 2000. Am. J. Kidney Dis. 37 (Suppl. 1): S7–S64.

      2 2 National Kidney Foundation (2001b). NKF‐K/DOQI clinical practice guidelines for vascular access: update 2000. Am. J. Kidney Dis. 37 (Suppl. 1): S139–S140.