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Radial Access Contralateral AV Fistula Protection — ESENeph MCQ

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EasyHaemodialysisRadial Access Contralateral AV Fistula ProtectionESENeph

A 70-year-old woman on haemodialysis has a well-functioning left radiocephalic fistula. She requires a coronary angiogram via radial artery access. What arterial access should be used?

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

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Correct answer: A — Right radial artery — contralateral to fistula

Arterial puncture of the radial artery IPSILATERAL to an AV fistula must be avoided. The radial artery feeds the fistula — damage from catheterisation (dissection, thrombosis, spasm) could compromise fistula flow or cause steal. Contralateral radial access (right side in this case) is preferred. If contralateral radial is not feasible, femoral access is an alternative. The AV fistula arm should be protected from arterial and venous puncture (except for dialysis needling), BP measurement, cannulation, and tourniquet use. This principle extends to any invasive vascular procedure and should be communicated to all healthcare teams.

Reference: UKKA 2020 – Vascular Access Guidelines; BSR 2019 – Angiography Access and AV Fistula