I read somewhere (maybe even on this board), that a complete acessment should be done before each dialysis treatment starts. Except for a couple of things, my nurse doesn't do any kind of an acessment. Please explain what's done in an acessment.

Dear Nancy,

Your question is very similar to Grace�s (stethoscope post). So the answer has much of the same information.

The pre-dialysis and post dialysis assessment includes a basic physical exam.

Vital Signs: Heart rate (pulse), breathing (may be rate or a question about shortness of breath), temperature and blood pressure.

Other assessment items: signs of fluid overload such as edema (swelling), lung sounds, questions about any chest pain, bruit and thrill in an AV graft or fistula, AV graft or fistula exam for any signs or symptoms of infection, catheter exit site exam for any signs or symptoms of an infection, questions about how you feel and if you any complaints (headache, cramps, nausea/vomiting, cold symptoms, pain, or how well you are eating.)

Your AV access (graft or fistula) should also be assessed with a stethoscope. The access should be palpated (felt with the finger tips) for the thrill (buzzing feeling within the vascular access). The vascular access should be osculated (listen to with a stethoscope) for the swishing sound within the access. The access should be check every day by you at home for the thrill. Feel over your access for the buzz. If the thrill is absent, you need to notify the dialysis unit. The bruit and thrill are the physical signs that the vascular access has blood flow through the access and is not clotted. The dialysis staff should at least feel for the thrill before placing any needles each treatment. If the thrill is weak or absent, then the staff member needs to listen for the bruit before sticking a needle into the access. If the access is clotted, no needles should be placed into the access �just to make sure it is clotted�. The access assessment can determine if the graft or fistula is open with a blood flow or clotted.

The NKF DOQI Guideline 10 recommends a physical exam of the graft or fistula be performed weekly as a minimum. DOQI Guidelines are online www.kidney.org under DOQI Vascular Access. (now called K/DOQI)

Ask the staff to explain the assessment area of the hemodialysis flowsheet to you. They must chart the results of the assessment pre and post dialysis. Each dialysis unit has a specific flowsheet and nursing procedure. You want to make sure the staff is performing the full assessment each treatment. Thanks for the great question.

Deborah

Medisystems has videos that are really helpful for teaching nurses, techs and even patients to do vascular access exams. We use them in our orientation program. They are very helpful and they are FREE.