Arteriovenous (AV) fistula
Arteriovenous (AV) fistula is a procedure that connects the artery and vein, causing the blood flow to move directly from an artery into a vein, increasing blood pressure and the volume of blood flowing through the vein. The procedure is typically performed on patients who require dialysis to assist failing kidneys by creating an access point to the dialysis machine, typically on the arm or wrist. The AV fistula is performed approximately 6 months before the first session of dialysis.
Known to be the longest lasting type of dialysis solution, the AV fistula procedure allows treatment to be performed by inserting two needles into the AV fistula. As one needle extracts the blood into the machine for filtration, the second needle allows the filtered blood to safely return to the body.
Pre-operative Assessment
- To find the best place for your access, the surgeon needs to have a picture of your blood vessels before he or she does surgery. This test is called “vessel mapping.” It is a simple test done with an ultrasound machine.
- Explanation of the operation and risks
Things to do before surgery:
- You need to take care of your veins – exercise regularly using a soft ball.
- Don’t let anyone take blood or check blood pressure over the upper limb.
- Let your Hemodialysis (HD) team know the date of your scheduled surgery.
On the day of surgery:
- You will not be able to drive home after surgery. Please come with a companion to take you home, or make sure to have transportation plans arranged.
- Do not fast and take all your medications as usual.
- Bring all your medications on the day of the surgery.
- Inform if you have allergies.
- Inform if you had a problem with anesthesia.
Please note:
- The operation will be done under local anesthesia.
- A written consent will be obtained.
Post Surgery
Immediate Post Surgery
- There may be some swelling around the operation site for a few days. Some bruising is to be expected.
- There will be a clear plaster dressing covering the wound which will be removed during the review. You can shower after the surgery with the dressing on. Gently pat dry and do not rub the dressing.
- Please complete the medication as prescribed.
- Bleeding is a risk, although it rarely happens. If it does happen, apply direct pressure to the wound and raise the arm, then phone for advice – please refer to the contact details below.
- Avoid lying on the operated side and keep the arm elevated on a pillow.
- You should use the arm and hand as normally as possible, but avoid direct pressure on the fistula. It may be helpful for someone to help you with normal daily activities; such as shopping, cooking and lifting for a few days after the surgery. You should not drive for at least 2 weeks until you have a full, pain-free use of the arm.
- You may feel cold, numbness or pins and needles in the hand especially in the finger closest to the wound. Usually this is mild and settles down over time, but please contact us if it continues or is uncomfortable.
- You will be able to feel a buzzing sensation around the area. This is known as the “thrill”.
- You are advised to check if the thrill is present twice daily; in the morning and evening. If no buzz can be felt or it feels weaker, you must inform your doctor.
Take home message
- Check your vascular access daily for signs of infection such as redness, pus and swelling.
- NEVER let anyone place a blood pressure cuff on the fistula arm.
- NEVER let anyone take blood or set IV drips in the fistula.
- Do not wear watches or tight clothes on your fistula arm.
- The fistula should only be used for hemodialysis.
- Do not lift heavy loads (e.g. shopping bags) with your fistula arm.
- Make sure that all healthcare providers clean their hands with soap and water or alcohol-based hand sanitizer before and after caring for you or your vascular access site.
- Exercise your hand immediately after operation.
- Drink plenty (within your personal fluid restriction if you have one), as dehydration reduces the blood flow through the fistula. Dehydration can also occur in hot weather and during any illness which causes diarrhoea or vomiting.
- Keep the arm warm, avoiding prolonged exposure of your fistula arm to extreme cold as this reduces the blood flow in the fistula.