One disadvantage of a fistula is an increase in

• A. Decreased healing
• B. Time to mature
• C. Higher infection risk
• D. Cannulation difficulty

Answer: (B)

The main idea here is that a fistula must go through a maturation period before it can be used for dialysis. After surgical creation, the vein and artery need time to remodel, dilate, and strengthen so that cannulation can be repeated safely. This maturation typically takes weeks to months, during which the access isn’t usable for dialysis and a catheter is often needed temporarily. That waiting period is the key disadvantage because it delays starting use of the fistula and can expose the patient to catheter-related complications, such as infection, until the fistula is ready.

Other choices don’t fit as the primary drawback. A fistula generally has lower infection risk than a catheter or graft once matured, and cannulation becomes easier after maturation rather than harder. Decreased healing isn’t the central issue, and any initial cannulation difficulty is temporary and resolves once maturation is complete.