A well functioning AV fistula /graft is the most important requirement of a hemodialysis patient. Patients can themselves look for the functioning of a fistula by placing their hand over their fistula and listening for the “thrill”. It is a simple yet very useful test which can be done by the patients themselves with a little teaching from the physician/Nephrologist. Blockade of a fistula is a patient’s as well as a Nephrologist’s nightmare and the scientific term is thrombosis. It is often detected in bedside by the sudden disappearance of the thrill. An astute patient often detects it early and reports to his doctor. If detected early it can be treated by a procedure called declotting wherein we remove the blood clots in the fistula/graft by aspiration, lysis with drugs, balloon angioplasty or a combination of them. A timely treatment can save a fistula and prevents the need for dialysis catheters and new fistula creation.