A client agrees to receive long-term hemodialysis to treat acute renal failure. For which surgical procedure should the nurse instruct this client?
A) Insertion of a double-lumen catheter into the subclavian artery
B) Placement of a peritoneal catheter
C) Insertion of a subarachnoid-peritoneal shunt
D) Placement of an arteriovenous fistula
Answer: D
For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis and not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebral spinal fluid and not for hemodialysis.
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