Dialysis Access Care
Physical Assessment
Paying attention to your access and treating any problems as they occur will ensure your access will last longer and function better. How do you pay attention to your access? Evaluate it daily. Look for subtle changes which can occur over days, weeks, months, or even years. Since you are the one living with your access, you are in the best position to notice changes as they occur. Early identification can allow for timely treatment before the issues become more serious and complicated.
For you, monitoring your access is as simple as 1-2-3.
STEP 1: Look
Inspect the skin over your access. Things to look for might include: changes in skin color, swelling, redness, enlarging bumps (aneurysms) and scab formation to name a few. If you notice any changes, give us a call or bring it to the attention of your dialysis healthcare provider.
STEP 2: Feel
Know how your access feels. If you notice any change in how it feels: either stronger or weaker, bring it to the attention of your caregiver. The ideal access will have a palpable thrill which is a vibrating, purring type of sensation that you will be able to feel when you place your hand over your access. If your access has a thrill and you notice that it is less pronounced or if the thrill changes to a pulsation where you feel the blood pounding through your access, either of these changes should be reported. If your access does not have a thrill but is pulsatile, that may be normal for you. If you notice that this pulse becomes either weaker or stronger when feeling your access, be sure to report this to your caregiver. A change in how the blood flows through your access (change in pulse or thrill), which is what you will be feeling when you palpate your access, could represent problems developing within your access. If you notice any changes, let your dialysis caregivers know.
STEP 3: Listen
What you feel can also be heard using a stethoscope. When listening to your access, you will hear a whooshing sound called a bruit (pronounced “broo-ee”). A normal bruit will be low-pitched and continuous. The bruit will be strongest where the graft or fistula is connected to the artery. This is typically near the area on your arm or leg where you have a scar from when your access was placed. If unsure, ask your caregiver at your dialysis unit or one of the staff members at Open Access the next time you visit our center. The bruit should be loudest near the arterial connection and it will diminish down the course of the access. If you notice any high-pitched sounds, these may suggest underlying narrowings that may be altering the blood flow through your access which may need to be corrected. Just like with looking and feeling, any changes heard should be reported to your caregiver for optimal access function.