Initiating Hemodialysis with AV Access
Key Takeaways
- Treatment initiation requires matching the patient, prescription, access, dialyzer, circuit, dialysate, and machine safety checks.
- Arterial and venous bloodlines must connect to the correct needles using aseptic technique and secure line routing.
- Blood flow is started and adjusted only according to order, training, and facility protocol while pressures and sites are observed.
- Early abnormal pressures, leaks, pain, swelling, or patient symptoms require prompt troubleshooting and escalation.
Starting Treatment Through AV Access
Before initiation, confirm the correct patient and prescription. The machine should be prepared according to the prescription, the extracorporeal circuit should be primed, alarms should be active, and dialysate safety checks should be complete according to facility procedure.
Needle placement and bloodline connection are linked. The arterial bloodline must connect to the arterial needle, and the venous bloodline must connect to the venous needle unless a qualified clinician directs otherwise under policy. Lines should be visible, secure, free of kinks, and routed to avoid pulling.
| Check before increasing blood flow | Why it matters |
|---|---|
| Correct lines and clamps | Prevents recirculation, blood loss, and flow failure |
| Needle sites visible | Allows rapid recognition of bleeding or infiltration |
| Arterial and venous pressures | Shows whether flow through the access and circuit is reasonable |
| Patient response | Detects dizziness, pain, anxiety, chest symptoms, or shortness of breath |
The blood pump is started and increased according to the prescription and facility protocol. The technician watches the access, pressures, venous chamber, bloodlines, and patient response during the first moments instead of walking away after connection.
Documentation usually includes start time, access used, needle gauge if required, initial blood flow, ordered settings, heparin steps if within role, vital signs, and any abnormal finding or report. Exact entries follow the facility record system.
During initiation, the technician notices that the venous bloodline has been connected to the arterial needle before the pump is started. What should the technician do?
Soon after treatment begins, the arterial pressure becomes much more negative than expected. Which response is most appropriate?
Which finding during the first minutes of AV access treatment requires immediate attention rather than waiting for the next routine check?