CDN Vascular Access Management 1 — Questions and Answers
Question 1: Which type of vascular access is considered the gold standard for hemodialysis?
- Tunneled cuffed catheter
- Arteriovenous fistula (Correct answer)
- Arteriovenous graft
- Non-tunneled catheter
Correct answer: Arteriovenous fistula
The arteriovenous (AV) fistula is the gold standard for hemodialysis access due to its lower infection risk, longer patency, and better outcomes.
Question 2: What is the recommended minimum maturation time for an AV fistula before first cannulation?
- 1–2 weeks
- 2–4 weeks
- 6–8 weeks (Correct answer)
- 3–6 months
Correct answer: 6–8 weeks
An AV fistula should mature for at least 6–8 weeks before cannulation to allow adequate vessel dilation and wall thickening.
Question 3: A patient's AV graft has a palpable thrill that becomes weaker than usual. What does this most likely indicate?
- Aneurysm formation
- Infection
- Thrombosis or stenosis (Correct answer)
- Hypotension
Correct answer: Thrombosis or stenosis
A weakened or absent thrill in an AV graft suggests reduced blood flow, most commonly caused by thrombosis or upstream/downstream stenosis.
Question 4: Which cannulation technique involves rotating needle insertion sites along the entire length of the fistula?
- Buttonhole technique
- Rope-ladder technique (Correct answer)
- Area technique
- Single-needle technique
Correct answer: Rope-ladder technique
The rope-ladder technique distributes needle punctures along the entire length of the access, reducing localized damage and aneurysm formation.
Question 5: When assessing a tunneled hemodialysis catheter for infection, which finding requires immediate removal of the catheter?
- Mild exit site redness
- Tunnel infection (purulent drainage along the tunnel) (Correct answer)
- Superficial skin irritation
- Slight blood-tinged drainage at exit site
Correct answer: Tunnel infection (purulent drainage along the tunnel)
A tunnel infection with purulent drainage along the subcutaneous catheter tract indicates deep infection requiring catheter removal and systemic antibiotics.
Question 6: What is the correct response when a dialysis patient arrives with a non-tunneled temporary catheter and reports pain, swelling, and redness at the insertion site?
- Increase heparin lock volume
- Proceed with dialysis using reduced blood flow
- Notify the physician and withhold dialysis pending evaluation (Correct answer)
- Apply warm compress and continue treatment
Correct answer: Notify the physician and withhold dialysis pending evaluation
Signs of catheter site infection require prompt physician notification and access evaluation before dialysis proceeds to prevent bacteremia.
CDN Vascular Access Management 1
Which type of vascular access is considered the gold standard for hemodialysis?