A Dialysis Access is a place which is constructed to allow doctors and nurses to have easy access to your blood circulation during haemodialysis. It is constructed situated just under the skin usually on your arm or sometimes on your thigh.
There are 2 types of AVF / Dialysis Access
- Arterio-Venous Fistula
The surgery will increase the blood flow in the fistula resulting in an increase in the diameter of the vein and the thickness of the vein wall which is important for the maturation of the site. The time for maturation ranges from 6-9 weeks before it can be used. If the fistula fails to mature, an additional procedure (such as Fistuloplasty or Balloon Assisted Maturation) or open repair may be required.
A graft is placed under the skin and it bridges the artery and the vein. Grafts do not require time for maturation and can be used after 2-3 weeks once the swelling has subsided. A graft may be required for patients with veins that are too small for fistula creation. The disadvantage of a graft is that it has a shorter lifespan than a fistula and has a higher rate of infection.
What happens before the surgery?
The surgery is usually performed as a day ward admission under local anaesthesia. The non-dominant arm is the preferred site. Your doctor will examine the blood vessels carefully and may also perform an ultrasound to choose the optimal site. Patients with diabetes, hypertension, heart failure or blood vessel disease may have poorer quality blood vessels to choose from.
What to expect after the surgery?
After surgery, it is advisable to keep the hand slightly elevated to reduce the swelling and take some analgesia to reduce any pain. The hand may feel slightly cold because blood may flow into the fistula resulting in less blood flow to the hand (known as ‘steal syndrome’). The wound care post-surgery includes the following:
- Ensure the wound is dry for at least 3 days
- Avoid lifting heavy objects exceeding 8kgs
- Avoid compression or sleeping on the arm
- Do some exercises like squeezing a soft ball to help healing and maturation
If there is excessive pain, swelling or bleeding, see your doctor as soon as possible
What are the possible complications?
The complications include narrowing of the vein, blood clots in the vein, swelling or aneurysm of fistula, wound infection and bleeding.
How to take care of the AVF / Dialysis Access?
Taking good care of your dialysis access is extremely important as it is the life line of all patients with kidney failure. See your doctor as soon as possible when you suspect there is a problem.
1) Check your fistula regularly. There is a buzz (‘thrill’) when the fistula is functioning properly
2) There is minimal bleeding after dialysis. If the bleeding is excessive or it takes longer than usual to stop, please inform your doctor, nurse or the dialysis staff
3) Try not to sleep on the arm with the fistula
4) The site of the fistula or graft must be kept clean at all times
5) Look out for signs of infection such as redness, swelling or pain
6) Do not wear tight clothing or jewelry which could block the fistula flow
7) Do not carry heavy objects using the hand with the fistula
8) Do not have blood or blood pressure taken from the arm with the fistula
9) Do not have any injections or drug infusions into the arm with the fistula
10) Do not apply any cream or lotion on the puncture site