CCHT Vascular Access and Cannulation 2

Question 1

What is the recommended needle gauge range for cannulating a mature arteriovenous fistula for standard hemodialysis?

Accepted Answer

17–16 gauge

Answer

20–22 gauge

Answer

14–15 gauge

Answer

25 gauge

Question 2

What is the 'buttonhole' (constant site) cannulation technique, and what is its primary advantage?

Accepted Answer

Cannulating the fistula at the exact same sites each treatment to create a fibrous tunnel, allowing blunt needle entry and reducing pain and infiltration risk

Answer

Cannulating the arteriovenous fistula at multiple rotating sites to prevent scarring and aneurysm formation

Answer

A special technique for cannulating a new fistula that has not yet matured

Answer

A technique used exclusively for patients with needle phobia involving a numbing cream applied before cannulation

Question 3

During needle removal at the end of hemodialysis, a patient's AV fistula site bleeds continuously for 20 minutes despite applying pressure. What should the technician do?

Accepted Answer

Notify the nurse immediately while maintaining firm, focused pressure on the needle sites without completely occluding flow

Answer

Apply more pressure and wait an additional 20 minutes before seeking help

Answer

Apply a tourniquet above the elbow to stop all flow through the fistula

Answer

Apply a hemostat (clamp) to the skin over the bleeding site

Question 4

What is the 'rope-ladder' cannulation technique for AV fistula access?

Accepted Answer

Systematically rotating needle insertion sites along the entire usable length of the fistula with each treatment

Answer

Inserting both needles in the same segment of the fistula to maximize blood flow rates

Answer

A specialized technique for patients with aneurysms that avoids the aneurysmal segment

Answer

Inserting needles at the same site using a new needle track at a slightly different angle each treatment

Question 5

What are the signs and symptoms of arteriovenous fistula infiltration (extravasation) during hemodialysis?

Accepted Answer

Swelling, pain, and hardness at or near the needle site, often accompanied by a pressure alarm change

Answer

Decreased venous return pressure and increased blood flow rate through the circuit

Answer

Increased thrill and bruit indicating improved flow to the fistula

Answer

Decrease in temperature at the fistula site without swelling or pain

Question 6

When inserting the arterial needle into an AV fistula for hemodialysis, in which direction should the needle bevel face and why?

Accepted Answer

Bevel up (facing away from the vessel wall) to facilitate entry into the lumen and optimal blood inflow

Answer

Bevel down (facing the vessel wall) to prevent the bevel from sucking against the vessel wall

Answer

Needle direction does not affect blood flow and is based on technician preference

Answer

Bevel toward the arterial anastomosis to align with the direction of blood flow