Q: 54 year old male with CKD-5 but not yet initiated on hemodialysis (HD) is admitted to ICU with volume overload. Patient informed you that he already has ArterioVenous Fistula (AVF) created in his upper arm a week ago in anticipation of HD. Your next step

A) Insert temporary HD catheter
B) Use AVF
C) Use AVF fistula only if thrill is palpable
D) Conservative management till AVF mature


Answer: A

By Anatomy, veins are usually thin-walled and relatively fragile.  Creation of AVF subjects vein to high pressure and high flow, and causes a series of changes characterized by dilation and thickening of the venous wall. It requires at least 2 weeks of time period for AVF to be stable/mature to access. Accessing AVF prior to maturation may cause life-threatening bleeding and complications. 


Reference: 

Pisoni RL, Young EW, Mapes DL, et al. Vascular access use and outcomes in the U.S., Europe, and Japan: results from the Dialysis Outcomes and Practice Patterns Study. Nephrol News Issues 2003; 17:38.