skip to main content

AV Fistula Needle Infiltration — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

EasyHaemodialysisAV Fistula Needle InfiltrationESENeph

A 60-year-old man with CKD G5D is receiving haemodialysis via a left brachiocephalic AV fistula. During cannulation, he reports severe pain at the needle insertion site and the arm begins to swell rapidly. There is no blood return from the arterial needle. What has occurred?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Arterial needle infiltration/extravasation – the needle has punctured through the vessel wall

Sudden pain during cannulation with rapid swelling and no blood return indicates needle infiltration (the needle tip has perforated the vessel wall and fluid/blood is extravasating into surrounding tissue). Management: immediately remove the needle, apply firm pressure for 10-15 minutes, apply ice, and elevate the arm. Do not attempt to re-cannulate the same site. If dialysis is urgent, the contralateral arm or a temporary catheter may be needed. Document and report the event. Frequent infiltrations may indicate access problems requiring investigation.

Reference: UKKA 2019 – Vascular Access; Kidney Care UK – Cannulation Guidance