A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?

Rationale: A. A raised red rash around the fistula site is incorrect because this typically indicates local infection or irritation, not venous insufficiency. Infection requires prompt evaluation and treatment but is distinct from vascular complications. B. Foul-smelling drainage from the fistula site is also indicative of infection rather than venous insufficiency. It is important to monitor, but it is not a primary sign of compromised venous flow. C. Pain in the right arm proximal to the fistula site is correct because venous insufficiency or outflow obstruction can lead to swelling, aching, and discomfort proximal to the fistula. When venous return is impaired, blood can pool in the arm, causing pain, edema, and sometimes skin changes. This is an important complication to recognize and report to the healthcare provider to prevent fistula dysfunction or thrombosis. D. Cold and numbness distal to the fistula site is incorrect because this is a manifestation of arterial insufficiency, not venous insufficiency. Arterial compromise results in decreased perfusion to the hand and fingers, leading to pallor, coolness, numbness, and potentially ischemia.