Progressive Care Nursing Certification (PCCN) Practice Exam

A patient with ESRD and HF is receiving HD through an AV graft and is experiencing bleeding. What should the nurse do first?

1. Assess for bruit and thrill every 30 min for 2 hours

2. Notify the interventional radiologist

3. Ask the nephrologist to insert a temp catheter

4. Collaborate regarding not using heparin during dialysis

The correct answer is: Notify the interventional radiologist

In a situation where a patient with end-stage renal disease (ESRD) and heart failure (HF) is experiencing bleeding from an arteriovenous (AV) graft during hemodialysis (HD), the priority is to ensure the patient's safety and manage the immediate complication. Notifying the interventional radiologist is essential because they are specialized in vascular access and can address issues related to the AV graft effectively. This action is crucial as the interventional radiologist can quickly assess the source of bleeding, determine whether there are complications related to the graft, and initiate appropriate interventions, such as repair or modification of the graft. Meanwhile, other responses may take longer to implement or may not address the immediate risk of significant blood loss. It's vital to act swiftly in cases of potential hemorrhage to prevent further complications. While assessing the bruit and thrill can provide information about the patency of the AV graft, it does not directly address the urgent bleeding issue. Similarly, inserting a temporary catheter or discussing the use of heparin may be relevant considerations but are not immediate interventions for managing active bleeding. Prompt communication with the interventional radiologist is the most effective first step in this scenario.