Care of your arteriovenous fistula (AVF) after surgery

This leaflet explains how to care for your fistula, which is a join made between an artery (which normally brings blood from your heart) and a vein (which normally returns blood to your heart) in your arm. Your doctor will have discussed your need for a fistula with you

How long will my wound take to heal?

• Your wound will take 10-14 days to heal.
• We advise that the dressing stay dry for at least three days before being changed. You will be given several spare dressings.
• Keep your wound covered for seven days.
• Avoid any heavy lifting/ pressure with your fistula arm for two weeks.
• Do not keep your fistula arm bent for long periods.

The majority of people will have dissolvable sutures. We will advise if stitches/ clips need to be removed. If you are a dialysis patient, we will remove the sutures in the dialysis unit. If you are not on dialysis, we will ask you to go to your nearest haemodialysis unit or to your General Practice (GP) (see below) to remove the sutures. We can also organise your district nurse to visit you to remove the sutures. If the surgeon has used a transparent sterile spray dressing, this will normally fall off after a few days.

Will I need a follow-up appointment?

You will be seen by a nurse in your renal unit directly after your surgery to check that your wound is healing and that the fistula is working.

• If you are not yet on dialysis, your fistula will be checked about six weeks after your surgery by a low clearance nurse and surgeon/ access nurse.
• If you are already on dialysis, your nurse will check your fistula in six weeks and start to use it for dialysis when ready.

When can I go back to work?

This will depend on the type of work you do. Please ask your nurse or doctor for advice.

When can I drive again?

We generally advise no driving for at least three days after your surgery.

What happens if my hands/ fingers start swelling?

Sometimes hand or fingers may swell after the operation; this is normal. It can be relieved by elevating your arm on several pillows when resting, and avoiding wearing rings, elasticated sleeves, or wristbands. If the swelling continues, or you are worried your fistula is not working, please call us for advice. The telephone numbers are at the end of this leaflet.

How can I check if my fistula is working?

You must know how to look after your fistula when you are at home. Remember that your fistula is your lifeline for dialysis. You should check twice a day that your fistula is working. This is done simply by looking, feeling and listening as follows:

• Place your fingers on the skin over your fistula; you should feel a vibration (‘thrill’).
• Listen for the ‘shoosh-shoosh’ noise (‘bruit’) made by your fistula.

How do I look after my fistula at home?

You play an important part in keeping your fistula healthy.

• Do not take blood pressure measurements from your fistula arm.
• Do not have any blood tests taken from your fistula arm.
• No needles, infusions, or drips are to go into your fistula arm.
• Do not wear any tight or restrictive clothing on your fistula arm.
• Avoid sleeping on your fistula arm.
• Do not use sharp objects near your fistula arm, for example razors.
• Avoid carrying heavy loads or shopping bags directly over your fistula.
• Do not remove scabs from the needle sites; this may cause bleeding or infection.
• A fistula wristband will be provided

Please note in an emergency these guidelines might not apply. You should be guided by the medical staff in attendance.

How can I help my fistula develop?

It can be six to eight weeks before a fistula is ready for haemodialysis.

Exercising your arm in which the fistula is created can help it to develop more quickly. You will be given a sponge ball to use to help with your fistula development. Place the ball in the hand with the fistula. Squeeze the ball repeatedly for five to 10 minutes; repeat this two to three times a day. If your arm becomes tired or painful during the exercises, stop and rest it.

What complications may occur?

Infection is not common in a fistula. If you develop pain, redness, or the skin around your fistula becomes hot please tell your nurse or doctor. You may need an antibiotic if an infection develops.

Thrombosis (blood clot) can be a cause of fistula failure, but this type of clot is not life threatening.

Arterial steal syndrome is caused by the fistula diverting too much blood into the vein, so your hand then receives less blood. The signs of steal syndrome are coldness in the hand or fingers. In mild cases this will be monitored; in more severe cases your fistula may need to be refashioned surgically.

If you are worried about any of the above, please call us for advice. The telephone numbers are at the end of this leaflet.

When is a fistula ready to use?

How quickly a fistula develops varies depending on how good your vessels are before surgery, and your general health.

A fistula is ‘mature’ (ready) when your vein has grown large enough and strong enough to support the required dialysis needles. This usually takes around six weeks, but it can take more, or less, time in some cases. Your dialysis nurse will check your fistula and will know when it is mature.

For the first few weeks, your fistula will be adjusting to being needled. During this time the walls of the fistula are quite soft, so sometimes the needle may need to be reinserted. This is common and does not mean that the fistula is not working properly.

Unfortunately, because the vein is now connected to an artery, failed needle sites are likely to bruise. This often looks worse than it is because the bruising is just under the surface of the skin and therefore spreads out sideways. As long as your fistula is working well you need not be concerned about this bruising, as it will slowly go away on its own. If you are concerned, always ask a member of staff.

If you have a central line in for dialysis, once your fistula is being used for dialysis, using two needles successfully for two weeks, your nurses will arrange for the line to be removed.

How long will my fistula last?

The majority of fistulas work immediately following surgery. You should remember that a successful fistula is less likely to form clots or become infected than other types of access. Also, fistulas tend to last years longer than any other kind of access.

However, a small number of fistulas never work and you might return from the theatre with a failed fistula. Fistulas can also fail at any stage, even after years of use, if you become ill or suffer an episode of low blood pressure. Other reasons can be direct trauma (knock or hit) to your fistula, infection, or a change in how your blood clots.What should I do if my fistula bleeds?

What should I do if my fistula bleeds?

Heavy bleeding is rare. If you have heavy bleeding that soaks through a dressing despite direct pressure, you should call 999 immediately to be taken to your nearest hospital. Do not delay getting help, as loss of consciousness can happen quickly from a haemorrhage.

The priority is to stop the bleeding by applying direct pressure to the area and elevating your arm. Do not use a large absorbent item such as a towel, as this disperses pressure. If you are on haemodialysis, your named nurse will give you a bleeding pack with instructions.

If your fistula bleeds after you get home, sit down and apply pressure with clean gauze for 10 minutes. If the bleeding does not stop after this time, please contact your renal unit or the Cambridge Dialysis Centre. If the unit is closed, dial 999.

After your dialysis sessions, a member of staff will apply pressure to the needling points to stop the bleeding. This generally takes five to 15 minutes, after which you can go home with gauze covering the sites.

Contact: Haemodialysis satellite units

Addenbrooke’s Hospital: 01223 245151; ask operator to bleep the transplant surgeon

Kings Lynn HD Unit 01553 613694

West Suffolk HD Unit: 01284 712921

Hinchingbrooke HD Unit: 01480 421850

Cambridge Dialysis Centre 01223 400180; access nurse direct line 01223 400182

References

1. The Renal Association and the British Transplantation Society. (01/06/11). Renal Association/ British Transplantation Society Standardised Patient Information Sheet. Making a fistula for haemodialysis.
2. British Journal of Renal Medicine (2004). “What I tell my patients about needing a fistula” Department of Health – N.S.F. for Renal Services Part 1 Standard 3. Dialysis and Transplantation

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