Updated on July 7, 2021

Arterio-Venous Fistula: How To Look After It

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 main types of Dialysis Access

  1. 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.
  2. Graft. 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 risk 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.

Click to view The Kidney Dr video on Dialysis Access

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 with the fistula
  • Do some exercises like squeezing a soft ball to help healing and maturation

What are the possible complications?

If there is excessive pain, swelling or bleeding, see your doctor as soon as possible. The possible complications include;

• narrowing of the vein
• blood clots in the vein
• swelling
• aneurysm of fistula
• wound infection
• bleeding.

How to take care of the Dialysis Access?

Taking good care of your dialysis access is extremely important as it is the life line of all patients with kidney failure.

DO heck your fistula regularly. There is a buzz (‘thrill’) when the fistula is functioning properly
DO keep the site of the fistula or graft clean at all times
DO look out for signs of infection such as redness, swelling or pain
DO inform your doctor, nurse or the dialysis staff if there is excessive bleeding or if it takes longer than usual to stop after a dialysis session

DON’T sleep on the arm with the fistula
DON’T wear tight clothing or jewellery which could block the fistula flow
DON’T carry heavy objects using the hand with the fistula
DON’T have blood or blood pressure taken from the arm with the fistula
DON’T have any injections or drug infusions into the arm with the fistula
DON’T apply any cream or lotion on the puncture site

See your doctor as soon as possible if you suspect there is a problem

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Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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