Which action is NOT recommended for a patient with an arteriovenous fistula for hemodialysis?

• A. Use the access arm for IV injections this shift.
• B. Do not take blood pressures on the access arm.
• C. Palpate for a thrill.
• D. Listen for bruit.

Answer: (A)

Protecting the fistula and keeping it patent is the main idea. A thrill felt over the fistula and a bruit heard with a stethoscope indicate that blood is flowing through the access, which means the fistula is functioning well. Using the access arm for IV injections this shift is not recommended because IV access can injure the fistula, cause infiltration or edema, increase infection risk, and potentially lead to thrombosis or loss of access. Not taking blood pressures on the access arm and routinely palpating for a thrill and listening for a bruit are appropriate ways to monitor patency and protect the dialysis access.