امرأة عمرها ٦٣ سنة على غسيل كلوي عبر ناسور في الذراع اليمنى. صباح اليوم بعد ليلة نامت فيها على ذراعها، لاحظت أن الذراع باردة قليلاً ولا تحس بالرعشة المعتادة فوق الناسور. الضغط ١٠٨/٦٤. ما التصرف الصحيح؟

A 63-year-old woman on haemodialysis via a right arm fistula slept on that arm last night. This morning the arm is slightly cool and she cannot feel the usual thrill over the fistula. BP 108/64. What is the correct action?

1. Apply a tight bandage on the arm to improve circulation
2. Notify the dialysis team or provider immediately for possible fistula thrombosis
3. Massage the fistula firmly for several minutes until the thrill returns
4. Wait for the next dialysis session in two days and report then

Answer: B) Notify the dialysis team or provider immediately for possible fistula thrombosis. An absent thrill usually means thrombosis; early intervention within hours may save the fistula. Sleeping on the arm and hypotension are risk factors.