# N7 · Access Assessment and Cannulation

Inspect, compare with baseline, and escalate a changed access before a preventable loss occurs.

![Infographic: N7 · Access Assessment and Cannulation](https://urinenephrology.org/visual-reference/images/nursing-n07.png?v=20261003c)

## Look before every needle

Inspect skin, swelling, redness, drainage, bruising, aneurysms, and healing wounds. Ask about pain, hand coldness, numbness, weakness, recent procedures, and prolonged bleeding after the previous treatment.

## Normal versus changed

Expected: a continuous, low-pitched bruit and a palpable thrill. New high-pitched or systolic-only sound, marked pulsatility, or weak/absent thrill needs assessment before routine cannulation. Compare with the patient’s usual examination.

## Do not needle an unsafe site

Absent thrill, uncontrolled bleeding, a fast-growing hematoma, a cold painful hand, or thin/ulcerated/scabbed skin over an aneurysm needs urgent review. Fever with access redness or drainage needs prompt assessment; do not wait for the next session.

## Cannulate the cleared access

Confirm clearance for use, access direction, appropriate needle sites, and the prescribed technique. Use trained help or ultrasound when indicated; avoid compromised skin and repeatedly puncturing the same small area.

## Time bleeding; preserve flow

After needle removal, apply direct pressure sufficient for hemostasis while maintaining the thrill, using trained technique. Record minutes to hemostasis. Repeated prolonged bleeding warrants access and anticoagulation review; avoid downstream compression.

## Handoff performance changes

Report examination findings, cannulation difficulties, pressures, achieved blood flow, alarms, clots, bleeding time, and adequacy trends. Include recent interventions and the agreed action before the next treatment.

## Supporting evidence

- [Supporting guideline or source](https://pmc.ncbi.nlm.nih.gov/articles/PMC8486643/)

## Source lessons

- [N7 AVF AVG Assessment and Cannulation](https://urinenephrology.org/mastery/maintenance-hd/nursing/N7-AVF-AVG-Assessment-and-Cannulation.html)

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