A client with chronic kidney disease has a subcutaneous arteriovenous fistula (AVF) placed in the nondominant left wrist for hemodialysis. Which of the following statements indicate the client understands how to care for the fistula properly? Select all that apply.

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11ecbb05_ca79_c090_b433_17446437474e_MD0009_00 The creation of an AVF for hemodialysis access involves an anastomosis between an artery and a vein (usually the cephalic or basilic vein). The fistula permits the arterial blood to flow through the vein, causing the vein to become larger in diameter and the walls to thicken, enabling blood to flow at high pressures. After the AVF is placed, it takes 2-4 months for it to mature to accommodate the repeated venipunctures necessary for hemodialysis access. The major complications of an AVF are infection (especially in end-stage kidney disease and diabetes), stenosis, thrombosis, and hemorrhage. Clients are taught the following preventive interventions: Report numbness or tingling of the extremity to the HCP to prevent neuromuscular damage (Option A) Do not allow anyone (other than dialysis personnel) to draw blood or take blood pressure measurements on the extremity to prevent thrombosis (Option B) Avoid wearing restrictive clothing or jewelry to prevent thrombosis Do not use the arm with vascular access to carry heavy objects (more than 5 lb [2.26 kg]); however, exercises to increase strength could include squeezing a soft ball or sponge several times a day (Option C) Check the function of the vascular access several times a day by feeling for vibration to assess for patency, stenosis, and clotting (Option D) Do not sleep on the arm with vascular access or use creams or lotions on the site (Option E) Monitor for signs of infection and bleeding after dialysis and report immediately Keep the site clean to help prevent infection Educational objective: The creation of an AVF for hemodialysis access involves an anastomosis between an artery and a vein. Clients are taught interventions to help prevent the major complications associated with an AVF (infection, stenosis, thrombosis, and hemorrhage).

A Client with Chronic Kidney Disease Has a Subcutaneous Arteriovenous