Nursing roles in vascular access surgery

Abstract

Dana P Slgley, FIN, BSN, is an operating room staff nurse, preceptor in general and vascular surgery, and member of the cardiac surgery team at Swedish Hospital Medical Center, Seattle. She received her BSN degree from the University of Washington, Seattle. atients requiring renal dialysis need readily available access to P their circulation to be connected to the dialysis unit. Because of our proximity to a major kidney center, we participate in many operations to create or alter blood access sites in patients in renal failure. The most frequently performed access procedures are the placement of an arteriovenous (AV) shunt (also called a Scribner shunt or cannula), arteriovenous (AV) fistula, and AV fistula using a graft. This article covers nursing roles in vascular surgery, different procedures, and the complications associated with them. A V cannula. Cannulas are often placed in patients in acute renal failure because they can be used immediately for dialysis. In this procedure, a tapered Teflon tip connected to a Silastic tube is inserted into an artery and another into a vein. The cannulas are brought through the skin and connected to each other externally when dialysis is not occurring. This allows blood to flow continually through the tubes to maintain patency of the system. Usually, these are placed in the patient’s forearm using the radial artery and the cephalic vein (Fig 1). If a patient is in chronic renal failure, however, a fistula or graft is preferred to a cannula because of less risk of infection and fewer other longterm complications such as clotting of the shunt and erosion of skin around the insertion area. AV cannulas last about three to six months. AV fistula. The best access for chronic hemodialysis is the AV fistula, in which the artery and vein are directly anastomosed (Fig 2). At our hospital, the cephalic vein is usually anastomosed to the side of the radial artery. The nondominant arm is used whenever possible. If a patient has had an AV shunt, it is possible to convert the shunt to a fistula by anastomosing the vessels in which the cannulas were placed. We