# AV Access: Look, Feel, Listen, Then Cannulate

Repeated trauma and unrecognized dysfunction accumulate. Document findings and communicate across the team so trends are acted on.

![Infographic: AV Access: Look, Feel, Listen, Then Cannulate](https://urinenephrology.org/visual-reference/images/mastery-hd-cannulation.png?v=20261003c)

## Clinical monitoring comes first

A functioning fistula or graft requires a usable flow pathway and healthy overlying tissue. Physical examination complements machine and surveillance data.

## Inspect before choosing a needle site

Redness, drainage, ulcerated or very thin skin, expanding aneurysm, new swelling, or hand pain/coolness requires assessment before routine cannulation. Do not needle through infected or compromised skin. Compare with prior findings and identify whether a usable safe segment remains.

## Connect examination to flow

A new weak or absent thrill may indicate poor flow or thrombosis; a markedly pulsatile access or abnormal bruit can suggest outflow trouble. Trained staff can use augmentation and arm-elevation maneuvers as appropriate. New changes plus difficult cannulation or prolonged bleeding should trigger access evaluation.

## Cannulate with a plan

Use trained technique and the prescribed approach, protect usable segments, and avoid damaged or infected areas. Maturation is a clinical assessment, not a date alone.

## Report dysfunction promptly

Prolonged bleeding, difficult cannulation, abnormal pressures, reduced delivery, or changed examination should trigger the established evaluation pathway.

## Preserve the access life

Repeated trauma and unrecognized dysfunction accumulate. Document findings and communicate across the team so trends are acted on.

## Source lessons

- [avf avg exam cannulation](https://urinenephrology.org/mastery/maintenance-hd/avf-avg-exam-cannulation.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.