NCLEX RN Practice Question 438

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Internal arteriovenous fistula


  • A permanent access of choice for the client with CRF requiring dialysis
  • The fistula is created surgically by anastomosis of a large artery and large vein in the arm.
  • The flow of arterial blood into the venous system causes the vein to become engorged (matured or developed).
  • Maturity takes about 4 to 6 weeks, depending on the client’s ability to do hand-flexing exercises such as ball squeezing, which help the fistula mature.
  • The fistula is required to be mature before it can be used because the engorged vein is punctured with a large-bore needle for the dialysis procedure.
  • Subclavian or femoral catheters, peritoneal dialysis, or an external arteriovenous shunt can be used for dialysis while the fistula is maturing or developing.


  • Because the fistula is internal, the risk of clotting and bleeding is low.
  • The fistula can be used indefinitely.
  • Fistulas have a decreased incidence of infection because it is internal and is not exposed.
  • Once healing has occurred, no external dressing is required.
  • The fistula allows freedom of movement.


  • The fistula cannot be used immediately after insertion so planning ahead for an alternate access for dialysis is important.
  • Needle insertions through the skin and tissues to the fistula are required for dialysis.
  • Infiltration of the needles during dialysis can occur and cause hematomas.
  • An aneurysm can form in the fistula.
  • Congestive heart failure can occur from the increased blood flow in the venous system.


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