Vascular Access: Assessment, Cannulation and Care
The Vascular Access domain tests assessment, cannulation and care of AV fistulas, grafts and central venous catheters, including recognition of stenosis, recirculation, infection and infiltration.
Core rules
- Assess AV access by palpating thrill, auscultating bruit, checking pulse augmentation and inspecting for redness or swelling.
- Rope-ladder cannulation rotates sites; buttonhole uses constant sites; the arterial needle is placed 2–3 cm above the anastomosis, and the venous needle several centimeters downstream.
- Catheters require strict aseptic technique, exit-site care and locking per protocol.
- Access flow monitoring and recirculation testing detect outflow stenosis before thrombosis.
Worked example
An AVF has a weak thrill and a high-pitched bruit that stops during arm elevation. Suspect stenosis; do not cannulate blindly. Notify the access team, avoid the suspected area and arrange flow or imaging assessment.
Traps
Do not cannulate an infiltrated site; do not assume a palpable pulse means adequate flow; do not use the access arm for BP or venipuncture; do not skip disinfection because the needle is “just” for dialysis.