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Fistula Arm Protection Absolute No Cannulation — ESENeph MCQ

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EasyHaemodialysisFistula Arm Protection Absolute No CannulationESENeph

A 55-year-old man with ESKD on haemodialysis via a well-functioning left brachiocephalic fistula is admitted for an elective right hip replacement. The surgical team wants to place an IV cannula in his left arm for intraoperative access. What is the correct response?

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Correct answer: D — Absolutely refuse — the fistula arm must be protected from ALL venepuncture, cannulation, and BP measurement

The AV fistula arm must be absolutely protected from venepuncture, IV cannulation, BP measurement, and tourniquet application by any healthcare team. Venous damage from cannulation can cause thrombosis, stenosis, or infection of the fistula — the patient's lifeline for dialysis. This protection must be communicated proactively to all healthcare teams (surgical, anaesthetic, ward nursing staff) using wristbands, signage, and verbal handover. Alternative IV access should be obtained in the contralateral arm, foot veins, or via a central line if necessary. This principle is non-negotiable and must be defended by the renal team — loss of a functioning fistula has serious long-term consequences for vascular access options.

Reference: UKKA 2020 – Vascular Access Guidelines; NICE 2019 – QS72 RRT; KDIGO 2019 – Vascular Access