Renal Replacement Therapy (Haemodialysis, Peritoneal Dialysis) — DCE Clinical Case

Approach — what the examiner is testing

This is not "look at a fistula". It tests whether you can confirm the access is functioning, hunt its complications systematically — especially steal, which the stem is pointing at — and complete the volume and cardiovascular survey that the fistula sits inside. The examiner watches the order (inspection before palpation before auscultation — never palpate away a bruit you have not described), the compression test for steal, and whether you synthesise rather than list [1].

Before touching the patient: look at both arms exposed to the shoulder and the chest wall. The access history is written on the skin — previous fistula scars (which level, which side), old catheter exit scars on the chest, and collateral chest-wall veins that whisper central vein stenosis from catheters past [1] [4].