Which day of the week is the best choice for his extraction?

Correct answer: C. Tuesday or Friday

• A. Treating IMMEDIATELY after a session is the wrong end of the window. Circulating heparin is still active, and the patient is hypovolaemic, hypotensive and fatigued from the fluid shift. Bleeding risk is at its highest.
• B. The interval two days after dialysis is workable but is not the optimum; the day immediately after the session is the established recommendation.
• C. CORRECT. Treat on the DAY AFTER dialysis. With Monday and Thursday sessions, that means TUESDAY or FRIDAY. By then the heparin has cleared — its half-life is short, so anticoagulation has resolved within a few hours — while fluid and electrolyte balance and blood pressure have stabilised, and uraemic toxins have not yet re-accumulated to the levels reached just before the next session.
• D. Treating just BEFORE a session means operating at peak uraemia, with the platelet dysfunction and bleeding tendency that uraemia produces, and with fluid overload and elevated blood pressure.

Note: Three further rules for the dialysis patient. NEVER take blood pressure or place a cannula in the arm carrying the FISTULA — use the contralateral arm. Adjust renally cleared drugs and AVOID NSAIDs entirely, since they are nephrotoxic and impair platelet function. Antibiotic prophylaxis is NOT routinely indicated for the fistula itself under current guidance, but a synthetic vascular GRAFT placed within the preceding six months, and any transplant patient on immunosuppression, warrant discussion with the nephrologist.