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89 Cards in this Set
- Front
- Back
The first permanent type access, the shunt was developed by:
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Scribner and Quinton
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An access in which there is a synthetic type material placed subcutaneously to join an artery and a vein is called a:
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Graft
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The fistula was developed by:
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Brescia and Cimino
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The correct angle in which to cannulate a fistula is:
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25-35 degree angle
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Factor(s) that affect access recirculation is (are):
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-Distance between arterial to venous needle tips
-Venous pressure -Direction of the needle tips |
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The formula for calculating access recirculation is:
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(Peripheral - Arterial) / (Peripheral - Venous) x 100
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An acceptable percentage of access recirculation in a fistula is:
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< 10%
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In a mature AV fistula or graft, what size of needle is needed to support the required blood flow rate for high-efficiency dialysis
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15 gauge
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AV fistulas should be mature in:
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6 weeks
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An internal access is clotted if there is:
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an absence of a thrill
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The purpose of a chest x-ray after the insertion of a permanent catheter is to:
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Confirm position and absence of pneumothorax
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Shunts are no longer used as a permanent access for hemodialysis due to the:
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-high incidence of infection
-Potential for hemorrhage -Use of fistulas and grafts |
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A disadvantage of an AV fistula over an AV graft is:
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The required length of time for maturity to take place
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Exercise for the development of an AV fistula should:
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-Begin 10-14 days post operative
-Take place after swelling of the anastomosis has diminished -Be performed 3-4 times a day, for 5-10 minutes |
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Proper maturation of an AV fistula:
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-Is necessary to avoid infiltration on cannulation
-Will enhance the life of the access |
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Thrombosis and subsequent loss of an AV access is attributed to:
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-Frequent hypotensive episodes
-Infections -Stenosis |
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Signs and symptoms of venous stenosis include
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-Recirculation > 10%
-High intradialytic venous pressure -Increase in midweek BUN |
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A major cause of aneurysms and psuedoaneurysms in an AV access is:
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Not rotating sites
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All of the following are true when cannulating an AV fistula:
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-Needles should be places at least 1-2 inches apart
-Using a tourniquet -Practicing good aseptic technique |
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Your patient complains of mild to moderate pain int eh access limb. The limb is noted to be cooler distally and paler than the other limb. The patient states that the pain increases in intensity while he is on dialysis. The patient could be experiencing:
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Steal syndrome
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Intervention for steal syndrome would include:
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Placing the affected extremity in a dependent position and keeping it warm
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Causes of an infection in an AV graft include:
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-Break in aseptic technique during cannulation
-Poor hygiene and care of the access arm -Bacterial seeding form another infected site in the body |
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While assessing an access before cannulation you note an aneurysm. You should:
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-Alert the physician
-Avoid cannulation of area -Note the size of the aneurysm |
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Patient teaching concerning an aneurysm includes:
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-Avoiding trauma to the area
-Reporting any signs of infection -Encouraging rotation of sites |
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Cannulation of an AV graft is best accomplished by using a 45 degree angle of the needle because it:
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Avoids destruction along the surface of the AV graft
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According to NKF DOQI guidelines, what is the correct order for the first and subsequent placement of vascular access?
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-A wrist (radial-cephalic) primary AV fistula
-An elbow (brachial-cephalic) primary AV fistula -An arteriovenous graft of synthetic material -A transposed brachial-basilic vein fistula |
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Subclavian vein catheterization should be avoided for temporary access due to the increased risk of:
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Central vein stenosis
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Referral for placement of permanent vascular access should be initiated when:
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The creatinine clearance is <25 mL/min
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A new primary arteriovenous fistula should be allowed to mature before cannulation for at least:
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6 weeks
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The risk of access thrombosis increases when:
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The graft blood flow is < 600 mL/min
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Access recirculation studies are relatively late predictor of venous stenosis. True or False
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True
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Measurement of recirculation is more useful in patients with AV fistula than those with grafts. True or False
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True
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The three needle peripheral vein method of measuring recirculation should not be used because it:
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-Overestimates access recirculation
-Requires unnecessary venipuncture |
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Venous stenosis contributes greatly to morbidity rates in hemodialysis patients because it:
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-Increases the risk of thrombosis
-Reduces the efficiency of the hemodialysis treatment |
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Degenerative changes within a graft of the overlying skin may lead to:
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-compromised circulation
-incomplete hemostasis on needle withdrawal -graft rupture |
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A primary AV fistula using the cephalic vein affords the best permanent access with the fewest complications. True or False
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True
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the use of cuffed catheters for chronic hemodialysis is associated with:
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-Lower blood flow rates
-Increased risk of infections -Patient reluctance to consider more permanent access options |
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Which fibrinolytic agent is the only currently available FDA approved drug for clearing thrombolytic occlusions in central venous catheters?
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Alteplase
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Arterial stenosis in an access is suspected if there is:
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A more negative arterial reading
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Complications associated with arteriovenous fistula for hemodialysis access include which of the following:
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Thrombosis, infection, stenosis, arterial steal syndrome
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infection is a serious complication in a graft because:
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There is a danger of graft disintegration and subsequent hemorrhage
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E.T. is a 62 year old female on hemodialysis. She has a left upper arm AV graft that has functioned well for two years. Recently, there has been suspicion that the percent recirculations in the graft may be rising. The suspicion is based on the observation of:
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Unexplained increases in BUN and creatinine
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in order to determine which end of a graft is anastomosed to an artery in a patient, the practitioner should:
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Press firmly with the two middle fingers at the midpoint of the graft and palpate for the thrill
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The practitioner should use which of the following actions to prevent venous aneurysms and thrombosis in a fistula?
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Rotation of puncture sites
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Correct treatment for a hematoma includes:
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Ice packs during dialysis
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One complication associated with a graft access device is:
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Stenosis at the venous anastomsis
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Aneurysm formation:
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Generally poses no problems unless it becomes thin walled
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When a needle is being removed from the arteriovenous fistula hemostasis is best achieved by:
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Moderate proximal pressure on the puncture sites
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Mr Brown, a 58 year old male, was started on hemodialysis emergently with a cuffed venous catheter. A chest x-ray was ordered post catheter insertion. An immediate complication, post insertion of a catheter that can be detected by x-ray is:
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Pneumothorax
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When assessing a tunneled catheter, you should inspect and palpate for signs of infection at the:
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Exit site
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Signs and symptoms of catheter malposition in the jugular vein include:
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Sudden ear ache on the side of the catheter
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Which intervention may correct catheter malfunction related to occlusion by a fibrin sheath?
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Thrombolytic therapy with TPA
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The patency of a catheter is usually maintained after dialysis by:
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Filling the catheter with heparin
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According to the NKF/DOQI Clinical Practice Guidelines on Vascular Access, quality of life and outcomes in vascular access could be improved with:
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Increased use of AV fistula and detecting dysfunction prior to thrombosis
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According to K/DOQI Vascular access guidelines, the preferred site of insertion for a central venous catheter is:
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Right internal jugular vein
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Which type of hemodiaysis vascular access comes closest to fulfilling the criteria of an ideal vascular access?
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AV fistula
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Which of the following statements about maturation of an AV fistula is not true?
a) Maturation describes the process whereby an artery increases in size and wall thickness over time b) Maturation occurs as a result of increased pressure flow and pressure within the vein c) An AV fistula can take from 4 weeks to several months to fully mature d) If the AV fistula does not appear to be maturing after 4-6 weeks, an interventional radiologist should be consulted |
a) Maturation describes the process whereby an artery increases in size and wall thickness over time
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The two most common complications associated with central venous access devices are:
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-Catheter related occlusion
-Catheter related infection |
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What observations would indicate a clotted fistula or graft?
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Absence of a bruit/thrill
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With central venous catheters, poor blood flow can be caused by all of the following:
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-Incorrect placement of the cannula within the host vessel
-Vascular spasms -An incorrect cannula lumen size |
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What is among the complications associated with an infected access?
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Bacterial endocarditis
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Recirculation is the mixing of outflow blood with inflow blood, leading to inadequate dialysis. All of the following conditions will contribute to recirculation during dialysis:
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-An access having a low blood flow rate through the vein of the graft
-An increase in venous pressure -Development of a stenosis at the arterial or venous end of the access |
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Correct needle placement is important in the initiation of dialysis to minimize the risk of all the of the following:
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-Recirculation
-Inadequate blood flow -Hematoma formation |
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The dialysis procedure is terminated. Before heparinizing and capping of the catheter, the practitioner should:
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Check manufacturer's specifications for catheter lumen volume
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The most common complication of an AV fistula is:
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Thrombosis
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The primary purpose of instilling a thrombolytic medication into a catheter is to:
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Improve the flow of solution
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The percent recirculation for a patient with a systemic BUN of 85mg/dL, an arterial BUN of 70mg/dL and a venous BUN of 25 mg/dL is:
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25%
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Which of the following statements regarding assessment of the vascular access is correct?
a) Changes int he bruit on auscultation may indicate stenosis b) Decreased venous pressure is a common normal finding c) Decreased percent recirculation may indicate stenosis d) Increased cannulation difficulty is a common, normal finding |
a) Changes int he bruit on auscultation may indicate stenosis
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In explaining recirculation studies to a new staff member, which of the following would you state?
a) The acceptable percent recirculation is less than or equal to 25 b) The acceptable percent recirculation is less than or equal to 35 c) The non-invasive method of performing recirculation studies may be more accurate than the traditional method d) The non-invasive method of performing recirculation studies is not as accurate than the traditional method |
c) The non-invasive method of performing recirculation studies may be more accurate than the traditional method
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A graft should be cannulated, by inserting the needle at an angle between:
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35-45 degrees
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Mr. Jones has a left lower arm AV loop graft that has functioned well for 2.5 years. Recently, there has been a concern that the percent recirculation in the graft may be increasing. Your concern is based on your observation of:
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Unexplained increases in BUN and creatinine
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Mr. Jones' percent recirculation is high. An angiogram is performed. Restenosis is noted in the venous end of the graft. In an attempt to prevent as much recirculation as possible, you place the venous needle:
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After the stenosis
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Mr Jones has angioplasty performed and the percent recirculation in the access decreases. To detect future problems, you pay most attention to:
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Venous pressures
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Ms Grace has an AV graft placed in her right upper arm. She complains of pain in her right hand that increases in intensity during hemodialysis. To decrease the pain you would:
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Keep the hand warm and dependent
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Grafts generally should not be cannulated for at least _____ weeks after placement and not until swelling has subsided so that palpation of the graft can be performed.
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2 weeks
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What is a risk factor for vascular access complications?
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History of hypotensive episodes
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Which procedure is necessary to be performed after the placement of a temporary or permanent catheter?
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Chest x-ray
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Mr D's internal jugular catheter works well for the first two hours of his treatment but suddenly does not provide adequate blood flow. The practitioner's first action, aside from checking the patient's blood pressure, would be to:
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Change the patient's position
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Mr. S's AV fistula has developed well and has now been used successfully for one week. The practitioner's concern for access longevity is best reflected by:
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Rotating of cannulation sites
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Non-thrombotic catheter occlusions are cause by:
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-Pinch-off syndrome
-Catheter malposition -Precipitates form IDPN, lipids or medications |
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The main complication(s) of central venous access devices is (are)
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-Mechanical occlusion
-Catheter related infection -Thrombotic occlusion |
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The primary sign or symptom of central vein stenosis is:
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Gross edema of the entire arm
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The three (3) components of the access physical exam are:
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Inspection, palpation and auscultation
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All grafts have a higher incidence of thrombosis then an AV fistula. True or False
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True
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A properly functioning AV graft should have:
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A continuous thrill at the arterial anastomosis, a soft compressible pulse and a lows pitched continuous bruit
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Superficial infections of AV grafts are generally associated with cannulation. True or False
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True
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Deep infections of AV grafts usually require surgical intervention. True or False
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True
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Mr smith has had angioplasty on his left lower arm graft. The venous pressure and percent recirculation in the access is within normal limits. Inhibition of clothing becomes a concern, therefore, the practitioner pays particular attention to the prevention of:
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Hypotension
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Which of the following methods define recommended K-DOQI first-choice surveillance methods and frequency for optimal vascular (AVF or AVG) access assessment?
a) Color-flow Doppler once per quarter b) Static Venous Pressure minimally every 2 weeks c) Dynamic Venous Pressure every hemodialysis treatment d) Dilution Technique once per quarter e) On-line Clearance (OLC) once per quarter f) All of the above EXCEPT C |
f) All of the above EXCEPT C
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