What are key aspects of caring for a patient with an arteriovenous fistula or graft for hemodialysis?

• A. Do not take blood pressures or insert IVs on the access arm, palpate for a thrill, listen for a bruit, protect access from injury, and monitor for infection or thrombosis.
• B. Draw blood from the access arm daily.
• C. Use the access arm for IV infusions during every shift.
• D. Apply a tourniquet around the access arm tightly.

Answer: (A)

Preserving the hemodialysis access is the main idea here. An arteriovenous fistula or graft must remain patent and free from injury, because it’s the lifeline for regular dialysis. The best care focuses on protecting the site, actively assessing its function, and watching for signs of trouble.

Do not use the access arm for blood pressure measurements or IV infusions. These actions can compress or injure the access, disrupt flow, promote thrombosis, or introduce infection. For patency, regularly check for a thrill and a bruit over the access: a palpable buzzing sensation (thrill) and an audible vibration (bruit) indicate that blood is flowing well. If these signs lessen or disappear, it can mean developing stenosis or thrombosis and warrants prompt evaluation.

Protect the access from injury by avoiding tight clothing, jewelry, or any traumas to the arm, and by not drawing blood from that arm. The arm should not be used for venipuncture or IV lines other than when specifically directed for dialysis.

Monitor for infection or thrombosis. Look for redness, warmth, swelling, or drainage around the access, fever, or sudden changes in the thrill or bruit. Also note distal signs like increased pain, pallor, or decreased distal pulses, which can signal compromised flow. If any abnormal findings occur, the healthcare team should be alerted promptly.