To differentiate arterial vs venous graft flow when uncertain, which technique is recommended?

• A. Check pulse in each limb
• B. Compress the graft in the middle and palpate each side
• C. Listen for bruit
• D. Observe color changes

Answer: (B)

Understanding arterial inflow versus venous outflow in a dialysis graft comes down to flow characteristics. Arterial flow is high-pressure and pulsatile, while venous flow in the graft is lower pressure and less pulsatile. Compressing the graft in the middle creates a temporary divider, allowing you to compare each side separately. If you palpate the side toward the artery, you should feel a stronger, more pulsatile thrill or pulse; the side toward the vein will have diminished pulsation. This direct side-by-side assessment is the most reliable way to distinguish which portion is arterial inflow versus venous outflow when the source isn’t obvious. Other methods like checking limb pulses, listening for a bruit, or watching for color changes don’t localize flow in the graft as clearly.