Which assessment should be reported to the healthcare provider immediately in a patient with a hemodialysis graft?

• A. Absence of a thrill over the graft site.
• B. Yellow, purulent drainage from graft incision site.
• C. Capillary refill >10 seconds in the hand where the graft is placed.
• D. Redness around the graft incision with warmth.

Answer: (B)

In a dialysis graft, signs of infection are an immediate red flag because graft infection can spread to the bloodstream and threaten both the graft and the patient. Purulent drainage from the graft incision means there is an active bacterial infection around the access site, which requires urgent evaluation, culture, and treatment with antibiotics, and may lead to graft removal if the infection cannot be controlled. This is why reporting yellow, purulent drainage right away is the most urgent finding.

Other signs are important too but not as immediately dangerous. Absence of a thrill suggests the graft may be occluded and not providing adequate blood flow, which needs prompt assessment. Redness with warmth can indicate cellulitis or localized infection but without purulent drainage, it’s a less urgent red flag than purulent drainage. Capillary refill delay signals distal perfusion problems, which is serious but not as emergent as a purulent infection around the graft.