Infection
• Is more common in grafts than in fistula
• A break in the use of the aseptic technique is the main cause of infection.
• Signs and symptoms of an infected graft:
• Redness
• Swelling
• Pain
• Fever
• Chills
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Stenosis
• Stenosis at the venous end of the graft is the most
common problem. i It can also develop along the length of the graft.
• Graft-vein stenosis develops when smooth muscle cells at the venous anastomosis grow more than they should.
• The cell form extra layers that fill up the graft lumen, reducing blood flow. This problem is called neointimal hyperplasia.
• Turbulence at either anastomosis and/or within the graft may play a role in this problem.
• KDOQI Clinical Practice Guidelines for Vascular Access recommend that grafts be checked for stenosis at least monthly.
• Grafts can be tested by measuring venous pressure or access flow.
Thrombosis
• Is the most common reason for AVGs to fail.
• A decreased or absent thrill/pulse is a sing of thrombosis.
• To check for thrombosis, look at the graft and palpate for thrill/pulse throughout the length of the graft.
• Teach patients how to palpate for the thrill/pulse in their access and report any changes to dialysis staff right away,
Steal Syndrome
• Can occur with grafts as well as fistula
• Some symptoms to watch for include pain, tingling, coldness, and a change in motor skills in the hand, blue nail beds, and/or decreased sensation in the access hand.
• The access surgeon should be told, so alert the nurse or nephrologist if you suspect steal syndrome.
• Try to keep the patient's hand warm during dialysis, perhaps with a mitten or tube sock.
• Changing the position of the patient's arm may help Increase blood circulation in the hand.
Dialysis Related Complications of Graft
The same dialysis-related complications that happen with fistulas also occur with grafts.
Complications Related to Poor Needle Insertion
• Pseudoaneurysm (a bubble-like blister in the graft caused by weakness in the graft wall) and graft collapse can occur if needle sites are not rotated well.
• For pseudoaneurysm to develop, the graft needs a defect and increased pressure from a venous stenosis.
• Each time a graft is cannulated, the needle cuts a hole in the graft.
• If the cannulation sites are not rotated, the holes will come together to form larger holes. Informally termed "one-site-itis", this overuse of the graft can have grave .consequences.
• The graft may start to come apart, which lead to graft collapse. At the same time, the frequent placement of needless in the same area damages the tissue above the graft, slowing healing and weakening all the protective skin layers.
• In time, the pressure of the blood flow - following the path of least resistance - will be stronger than the tissue covering it, and the pseudoaneurysm may rupture.
• If this occur, the patient can die ina matter of minutes if he/she is alone.
No graft should be allowed to reach this point.
• The graft may start to come apart, which lead to graft collapse.
• At the same time, the frequent placement of needless in the same area damages the tissue above the graft, slowing healing and weakening all the protective skin layers.
• In time, the pressure of the blood flow - following the path of least resistance - will be stronger than the tissue covering it, and the pseudoaneurysm may rupture.
If this occur, the patient can die in a matter of minutes if he/she is alone.
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