Urinary Disorders Q 82 - Gyan Darpan : Learning Portal
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Tuesday 5 April 2022

Urinary Disorders Q 82

What is the best way to check for patency of the arteriovenous fistula for hemodialysis?
    A. Pinch the fistula and note the speed of filling on release.
    B. Use a needle and syringe to aspirate blood from the fistula.
    C. Check for capillary refill of the nail beds on that extremity.
    D. Palpate the fistula throughout its length to assess for a thrill.

Correct Answer: D. Palpate the fistula throughout its length to assess for a thrill.

The vibration or thrill felt during palpation ensures that the fistula has the desired turbulent blood flow. Assess for patency at least every 8 hours. Palpate the vascular access to feel for a thrill or vibration that indicates arterial and venous blood flow and patency. Auscultate the vascular access with a stethoscope to detect a bruit or “swishing” sound that indicates patency.

Option A: Pinching the fistula could cause damage. To prevent injuries, place an armband on the patient or a sign over the bed that says no BP measurements, venipunctures, or injections on the affected side. When blood flow through the vascular access is reduced, it can clot.
Option B: Aspirating blood is a needless invasive procedure. Narrowing, also known as stenosis, of the blood vessel is the most common problem. This results in insufficient blood flow through the fistula or graft. Clotting can also cause decreased flow. If you don’t feel a thrill (vibration), the access may be clotted.
Option C: Patients with an AVF for hemodialysis will present with evidence of a surgical incision on the lateral wrist, volar forearm, or upper arm. A working AVF will have a palpable thrill and continuous bruit. Superficial fistulas have a palpable thrill, a bruit, or even a pulsatile mass. It may be possible to auscultate a machinery-like murmur over the fistula.

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