CDN Vascular Access Management 2 — Questions and Answers
Question 1: Which dressing change technique is used for the buttonhole cannulation method?
- Transparent occlusive dressing only
- Removal of scab with sterile technique before needle insertion (Correct answer)
- Betadine-soaked gauze left in place 24 hours
- Alcohol swab applied immediately before needle insertion
Correct answer: Removal of scab with sterile technique before needle insertion
In the buttonhole technique, the scab at the tract entrance must be removed using sterile technique before inserting the blunt needle to maintain tract integrity.
Question 2: What is a primary advantage of the buttonhole cannulation technique over rope-ladder technique?
- Higher blood flow rates
- Reduced cannulation pain and fewer hematomas (Correct answer)
- Lower infection risk than rope-ladder
- Faster fistula maturation
Correct answer: Reduced cannulation pain and fewer hematomas
Buttonhole cannulation uses blunt needles inserted into established tracts, significantly reducing pain and the risk of hematoma formation with each treatment.
Question 3: A patient on hemodialysis has a Kt/V of 1.1 and a recirculation rate of 22% in their AV fistula. What is the most likely cause?
- High blood flow rate
- Access stenosis causing venous hypertension (Correct answer)
- Low dialysate flow rate
- Patient non-compliance
Correct answer: Access stenosis causing venous hypertension
High recirculation rates in an AV fistula typically indicate venous outflow stenosis, which causes treated blood to re-enter the arterial needle before reaching systemic circulation.
Question 4: Which sign is the BEST indicator of AV graft thrombosis?
- Elevated blood pressure
- Absence of bruit and thrill (Correct answer)
- Increased access blood flow on monitoring
- Prolonged bleeding after needle removal
Correct answer: Absence of bruit and thrill
Loss of the bruit (audible sound) and thrill (palpable vibration) over an AV graft is the most reliable clinical indicator of thrombosis.
Question 5: What should the dialysis nurse do first when a patient experiences venous needle dislodgement during treatment?
- Apply pressure to the site and slow the blood pump
- Clamp the arterial line and return blood through arterial needle
- Immediately turn off the blood pump and apply firm pressure to the site (Correct answer)
- Increase the blood pump speed to prevent clotting
Correct answer: Immediately turn off the blood pump and apply firm pressure to the site
Venous needle dislodgement requires immediately stopping the blood pump and applying firm pressure to prevent significant blood loss.
Question 6: Which intervention is recommended to prevent steal syndrome in a patient with an AV fistula?
- Increase blood pump speed
- Apply warm compresses to the access arm
- Surgical banding or revision of the fistula (Correct answer)
- Administer vasodilators before dialysis
Correct answer: Surgical banding or revision of the fistula
Steal syndrome (ischemia distal to the AV fistula) is managed surgically through banding or revision to reduce blood diversion from the distal extremity.
CDN Vascular Access Management 2
Which dressing change technique is used for the buttonhole cannulation method?