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Atrium PTFE Vascular Graft Dialysis Education Ask, Look, Listen: Before Cannulation 1 Ask the patient if they have noticed any unusual symptoms concerning their access site or physical changes to their health such as dizziness or a high temperature. 2Conduct a visual exam of the access site. Report any signs of infection, such as redness, swelling, pain, fever or any drainage issues to the patients’ doctor. 3Feel for the thrill (vibration) and listen for the bruit with a stethoscope since grafts are generally thicker than native fistulas. Sometimes a thrill may not always be detectable. Upper Extremity Straight Prosthetic AV Accesses Upper Extremity Loop Prosthetic AV Accesses Thigh Prosthetic AV Accesses DOQI Guidelines for Proper Needle Cannulation* Post Cannulation Care of Synthetic Graft* • A clean, sterile technique should be used for all cannulation procedures. • Be sure to rotate cannulation sites. Avoid sticking the graft in the same location twice to reduce the risk of graft damage and possible pseudoaneurysm formation. • When stopping the bleeding at the needle site post dialysis, apply only enough pressure to stop the blood flow. Too much pressure may cause the graft to clot or block-off. • Make sure that the skin is stretched tight in the opposite direction of the needle insertion. This will help to stabilize the graft when cannulating. • Be sure to properly clean the access site after and between dialysis sessions. • Use a 45 degree angle of insertion for the synthetic graft. Note that this degree is different if you are cannulating a fistula. The 45 degree angle is necessary when cannulating a synthetic graft because it reduces the possible risk of tearing the graft. It also helps to prevent backwall sticking. Once the graft is punctured, advance the needle slowly with the cutting edge facing the top of the vessel. DO NOT ROTATE AXIS WHEN INSERTING THE NEEDLE. • Educate the patient on proper care of the access site and graft. For example, not to allow blood pressures to be taken on the arm with the graft, avoid carrying heavy packages, purses or a young child and to avoid constrictive clothing or jewelry as these may restrict blood flow through the graft and possibly cause it to clot. • Once the needle is in the desired position, it is safe to rotate the needle 180 degrees. Waiting to rotate avoids unnecessary damage to the top of the graft. • Remind them to take their medications as prescribed by their doctor as well as to follow their diet and exercise regimens. Also stress the importance of attending each dialysis session. • Once the needle is correctly placed, tape it at the same angle or one similar to the angle of insertion. Avoid pressing the needle shaft flat against the skin as this moves the needle tip from the desired position. Proper Needle Cannulation Proper Compression Technique Exceptional Strength, Handling and Durability Superior Kink and Compression Resistance The No Weep Guarantee™ Advancing Vascular Repair *National Kidney Foundation, DOQI Clinical Guidelines © Atrium Medical Corporation 2008. All Rights Reserved. Part # 0174. Printed in USA 9/08 www.atriummed.com