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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.

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