CCHT Vascular Access and Cannulation 3

Question 1

What is the minimum time a newly placed tunneled hemodialysis catheter should be used after insertion before the catheter tract is considered mature enough for routine use?

Accepted Answer

Catheters can be used immediately after placement and confirmation by chest X-ray

Answer

24–48 hours; during this period the catheter should be handled gently and the insertion site monitored

Answer

1 week; the catheter must not be used for 7 days to allow the cuff to become adherent

Answer

1 month; the patient should use a temporary catheter until the tunneled catheter matures

Question 2

A patient's tunneled catheter is found to have a blood flow rate of only 180 mL/min despite the prescription of 350 mL/min. After repositioning the patient and reversing the catheter lines, flow improves minimally. What is the likely cause and appropriate next step?

Accepted Answer

Catheter dysfunction from fibrin sheath or intraluminal thrombus; notify the nurse for consideration of thrombolytic therapy

Answer

The catheter is kinked at the chest wall; call interventional radiology for catheter revision

Answer

Air lock in the catheter lumen; flush with normal saline using high pressure to displace the air

Answer

The catheter tip has migrated to the subclavian vein; reassess position with ultrasound

Question 3

Which of the following is a sign of central venous stenosis in a patient with an arteriovenous fistula in the ipsilateral arm?

Accepted Answer

Edema of the entire arm, shoulder, neck, and face on the same side as the fistula

Answer

Hypotension during dialysis caused by high fistula flow

Answer

High venous return pressures during dialysis without arm swelling

Answer

Thrombosis of the fistula within the first month of creation

Question 4

What is the recommended order for accessing a hemodialysis patient's vascular access options, from most preferred to least preferred?

Accepted Answer

AV fistula → AV graft → tunneled catheter

Answer

Tunneled catheter → AV graft → AV fistula

Answer

Temporary catheter → AV graft → AV fistula

Answer

AV fistula → tunneled catheter → AV graft

Question 5

A dialysis technician notices that a patient's AV graft has an expanding pulsatile mass near the venous anastomosis. What does this likely represent and what action should be taken?

Accepted Answer

A pseudoaneurysm or true aneurysm requiring immediate reporting to the nurse and physician and avoidance of cannulation at that site

Answer

A mature graft segment with adequate flow; document and continue treatment

Answer

Air trapped in the subcutaneous tissue from previous needle removal; massage the area before cannulating

Answer

A lymph node reaction to synthetic graft material; continue treatment and mention at next physician visit

Question 6

What is the purpose of using a tourniquet when preparing to cannulate an AV fistula?

Accepted Answer

To increase blood pressure in the fistula, making it easier to visualize and palpate the vessel before needle insertion

Answer

To stop all blood flow to allow safer needle insertion without bleeding risk

Answer

To test whether the fistula is patent by checking if the thrill returns after tourniquet release

Answer

To reduce the patient's pain during needle insertion by creating distal ischemia