T5 · Dialysis access care
Risk Long-term illness
Definition
The dialysis access site may become infected, blocked, or damaged.- Needle sites
- poor care
- infection
- clotting
- Redness
- swelling
- no buzzing feel
- fever
📋 Scenario
A dialysis patient with a new fistula carries a heavy shopping bag on that arm.
Subjective (S): "I carry my shopping on that arm."
Objective (O): Fistula arm: pulse buzz present; skin clean, cool, no redness; carries a heavy bag on that arm; blood pressure was taken on that arm at the last visit.
Assessment tools for this scenario: CP-LONG Long-Term Condition Check CP-SKIN Skin & Wound Score CP-BREATH Breathing & Circulation Check
Validated scales to consider: Self-management review, Braden Scale, TIME wound chart, NEWS2, SpO₂, ECG
**CarePath diagnosis:** Dialysis access care related to poor care and pressure on the access arm (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Protect the arm. | Pressure, heavy loads or tight items on the access arm can squeeze the fistula and reduce blood flow, causing clotting and loss of the access. |
| No blood pressure or needles on that arm. | Pressure from a cuff or needle puncture can damage or block the fistula, so these are kept to the other arm. |
| Check the thrill. | Feeling the thrill, the buzz of blood flow, shows that the fistula is working. Loss of the thrill means a clot may have formed and needs urgent attention. |
| Keep clean. | Washing the arm, especially before dialysis, lowers germs on the skin and reduces the risk of infection at needle sites. |
| Report the blood pressure taken on that arm and any sign of infection. | The access arm must not have blood pressure cuffs or needles because it can damage the fistula, so the error is recorded and corrected. |
**Expected outcomes**
- No infection develops at the access site.
- Fistula keeps working.
- No complications.
- Patient protects the arm.
**Linking the data to the diagnosis**
This is a risk diagnosis because the fistula is working and no problem has occurred. The thrill is present and the skin is clean, cool and not red. However, the patient says, "I carry my shopping on that arm," carries a heavy bag on it, and had blood pressure taken on that arm at the last visit. These behaviors and poor care are the risk factors, so an actual infection or blockage statement would be wrong. The plan protects the arm, checks the thrill, keeps it clean and reports infection. The aim is that the fistula keeps working, there are no complications and the patient protects the arm.
CarePath diagnosis
Dialysis access care related to poor care and pressure on the access arm (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Protect the arm. | Pressure, heavy loads or tight items on the access arm can squeeze the fistula and reduce blood flow, causing clotting and loss of the access. |
| 2. No blood pressure or needles on that arm. | Pressure from a cuff or needle puncture can damage or block the fistula, so these are kept to the other arm. |
| 3. Check the thrill. | Feeling the thrill, the buzz of blood flow, shows that the fistula is working. Loss of the thrill means a clot may have formed and needs urgent attention. |
| 4. Keep clean. | Washing the arm, especially before dialysis, lowers germs on the skin and reduces the risk of infection at needle sites. |
| 5. Report the blood pressure taken on that arm and any sign of infection. | The access arm must not have blood pressure cuffs or needles because it can damage the fistula, so the error is recorded and corrected. |
Expected outcomes
- No infection develops at the access site.
- Fistula keeps working.
- No complications.
- Patient protects the arm.
Linking the data to the diagnosis
This is a risk diagnosis because the fistula is working and no problem has occurred. The thrill is present and the skin is clean, cool and not red. However, the patient says, "I carry my shopping on that arm," carries a heavy bag on it, and had blood pressure taken on that arm at the last visit. These behaviors and poor care are the risk factors, so an actual infection or blockage statement would be wrong. The plan protects the arm, checks the thrill, keeps it clean and reports infection. The aim is that the fistula keeps working, there are no complications and the patient protects the arm.