Access Assessment and Signs of Access Failure
Key Takeaways
- Access assessment happens before cannulation or connection.
- An AV fistula or graft should be checked for appearance, bruit, and thrill according to facility policy.
- Absent or changed bruit or thrill, infection signs, severe pain, swelling, or circulation changes require reporting before use.
- Catheter exit-site concerns and dressing problems are reported and handled within state and facility scope.
Check the access before use
Access assessment is a required pre-treatment clinical skill. Before cannulation or connection, inspect the access and surrounding tissue, ask about changes, and check function using the methods allowed by facility policy. The goal is to identify failure, infection, or circulation problems before the access is stressed by treatment.
For an AV fistula or AV graft, look for redness, warmth, drainage, swelling, bruising, skin breakdown, unusual aneurysm changes, scabs, or bleeding. Ask about new pain, numbness, coldness, tingling, hand color change, prolonged bleeding after the last treatment, or problems with previous cannulation.
Palpate for a thrill and auscultate for a bruit when that is part of the technician role. A healthy access usually has a continuous vibration or sound. An absent thrill, absent bruit, sudden weakening, high-pitched change, or other major change from the patient's usual finding may indicate stenosis, clotting, or impending failure.
Do not cannulate an access that has no thrill or bruit until it is evaluated by the RN or qualified staff. Starting treatment is not the way to test an access. The exam usually rewards the action that protects the access and patient first: stop, keep the patient safe, notify, and document.
Catheter assessment focuses on the dressing, visible site, patient symptoms, and policy-defined catheter checks. Report fever, chills, drainage, redness, tenderness, loose or wet dressing, exposed cuff, or catheter damage. Catheter care is often restricted by state law and facility policy, so stay within assigned duties.
Protect access limbs. Do not take blood pressure, draw blood, start IVs, or apply prolonged pressure on an access arm unless policy and qualified staff specifically direct otherwise. Avoid carrying heavy items or placing tight bands over the access area.
| Access finding | Why it matters |
|---|---|
| No thrill or bruit | Possible clotting or access failure |
| Redness, warmth, drainage | Possible infection |
| Arm swelling or prolonged bleeding | Possible stenosis or outflow problem |
| Cool hand, numbness, severe pain | Possible circulation compromise |
The CCHT exam often pairs a tempting shortcut with an access warning sign. If the access finding suggests failure, infection, or impaired circulation, the safe answer is escalation before treatment.
Before cannulation, the technician cannot feel a thrill or hear a bruit in the patient's AV fistula. What is the best next action?
A patient with a tunneled catheter has redness and drainage visible at the exit site during pre-treatment assessment. What should the technician do?
A patient reports that the access hand has become cold and numb since the last dialysis treatment. Which interpretation is safest?