Name two complications of long-term hemodialysis access (fistula/graft) to monitor for.

• A. Thrombosis and infection; monitor circuit; check for thrill/bruit
• B. Hypertension and electrolyte imbalance
• C. Liver failure and pancreatitis
• D. Hepatic abscess and pneumonia

Answer: (A)

Long-term hemodialysis access needs ongoing surveillance because blockage or infection can quickly render the access unusable. The two main complications to watch for are thrombosis (clotting) of the access and infection at the site. Thrombosis reduces or stops blood flow through the fistula or graft, compromising dialysis. The early signs are a diminished or absent thrill and a reduced or missing bruit over the access; regular checks of the access circuit during dialysis help detect this promptly so actions can be taken to salvage the access. Infection risk arises from repeated needle punctures and skin breakdown; look for redness, warmth, swelling around the access, fever, or purulent drainage. By actively monitoring for loss of patency (thrill/bruit) and infection signs, you protect the longevity and safety of the dialysis access.