Editing Medical-Surgical Nursing (section)

=== Dialysis Access and Care ===

For an arteriovenous fistula or graft, palpate for a thrill and auscultate for a bruit every shift. Never take blood pressure, draw blood, or start an intravenous line in the access extremity, and avoid constrictive clothing or sleeping on that arm.

Hold dialyzable medications, including many antihypertensives, until after treatment unless otherwise ordered, and weigh the patient before and after dialysis. Disequilibrium syndrome, caused by rapid solute shifts, presents with headache, nausea, restlessness, and confusion and requires slowing or stopping the treatment.

In peritoneal dialysis, cloudy effluent with abdominal pain and fever indicates peritonitis and must be reported and cultured. Outflow that is less than inflow suggests catheter obstruction or constipation; reposition the patient and check for kinks.