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AV Fistula Protection — FRCA Final MCQ

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EasyPreoperative AssessmentAV Fistula ProtectionFRCA Final

A 52-year-old woman (ASA III) with chronic kidney disease stage 5 on haemodialysis has a functioning left brachiocephalic arteriovenous fistula. She requires a right total knee replacement. Which of the following is absolutely prohibited?

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

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Correct answer: C — Both blood pressure measurement and venepuncture on the left arm

The arm with a functioning AV fistula must be protected at all times: no blood pressure measurement (cuff compression can damage the fistula), no venepuncture (risk of haematoma, infection, and fistula thrombosis), no IV cannulation, and no arterial line insertion. The fistula arm should be clearly labelled and all staff informed. The fistula thrill and bruit should be checked before and after anaesthesia. Pulse oximetry on the fistula hand is acceptable but may give inaccurate readings due to non-pulsatile flow.

Reference: NICE – 2019 – NG107 RRT and conservative management; RCOA – 2023 – Renal disease and anaesthesia