If you have end-stage renal disease (ESRD) and need dialysis, you may have an arteriovenous (AV) fistula as your dialysis access. An AV fistula is a surgical connection between an artery and a vein, usually in your upper limb that allows increased blood flow. The increased blood flow helps in accessing more blood to flow from your body to the dialysis machine and back easily – helping in faster and efficient removal of wastes and extra fluid.
The AV fistula is the preferred type of dialysis access because it lasts longer, has fewer complications, and provides better blood flow than other types of access.
However, having an AV fistula also requires some care and attention from you. You need to protect your AV fistula from infection, clotting, bleeding, and injury. You also need to monitor your AV fistula regularly and report any problems to your dialysis team. Here are some tips on how to take care of your AV fistula and keep it working well for you.
Before Dialysis
How can patients take care of AV fistula without the nurse's help?
Wash and pat dry your fistula arm thoroughly right before each treatment. Wash your arm with soap and water before each dialysis session. This helps prevent infection by removing dirt and bacteria from your skin. If you get a fever, this can be a sign of infection.
Check your AV fistula area for signs of infection, redness, swelling, warmth, pain, or pus. If you notice any of these signs, call your dialysis team right away.
Steps to evaluate AV fistula
- Feel your AV fistula for the thrill (vibration) by placing the palm of the other hand gently over the fistula. Some can hear the blood flow when the fistula is brought close to the ears. Vibration has to be felt always – if the vibration seems to have become fainter / no vibration is noted – indicates a problem with the fistula and needs to be informed and shown to the doctor immediately
- Sometimes you may notice small wounds / scabs on the fistula limb / at site of the cannulation – it is imperative to bring these to the notice of the nurses in the dialysis unit and also to the treating doctors. Any wounds if infected can lead to spread of infection into the bloodstream and need to be taken care of at the earliest.
Dos of AV fistula care
- Regular hand / arm exercises as taught by the doctor / staff have to be performed
- Observe for thrill / vibration over the fistula always
- Wear loose fitting clothes – so that fistula area is not compressed
- Keep your arm below the fistula height mostly
Don’ts of AV fistula care
- Avoid wearing tight clothing, jewellery, metal items or watch on your arm with the AV fistula. These can restrict blood flow and damage your AV fistula.
- Avoid lifting heavy objects or doing strenuous activities with your arm with the AV fistula. These can increase pressure and cause bleeding or rupture of your AV fistula.
- Avoid sleeping on your arm with the AV fistula. This can compress your AV fistula and reduce blood flow.
- Avoid driving a vehicle as it can put pressure on your arm.
During Dialysis
- Make sure that the needles are inserted correctly and securely into your AV fistula. If you feel any pain or discomfort during needle insertion or during dialysis, tell your dialysis staff immediately.
- Keep your arm still and avoid bending or twisting it during dialysis. This helps prevent needle dislodgement or movement that can cause bleeding or damage to your AV fistula.
- If required ask for a restraint to the upper limb with AV fistula so that you don’t move the arm inadvertently.
- Low blood pressures during dialysis can cause clotting of the AV fistula – hence avoid drinking too much fluid between 2 sessions of dialysis so that fluid removal need not be excessive on hemodialysis – this maintains good flow across the AV fistula.
After Dialysis
- After dialysis session, when at home, make sure to remove the upper belt / dressing over the AV fistula carefully – and after ensuring that no ooze / bleeding is noted, then only remove the lower belt / dressing of the AV fistula
- Keep the AV fistula upper limb clean. Infections are rare but can still happen. Keep it clear of any weight such as a watch, jewelry, or tight clothing on your fistula arm.
- Inspect your needle sites for signs of infection, such as redness, swelling, warmth, pain, or pus. If you notice any of these signs, call your dialysis team instantly.
- Repeat all the Steps to evaluate AV Fistula as mentioned above.
- Avoid using any products that can irritate or infect your skin, such as alcohol, perfume, lotion, or powder on your arm with the AV fistula.
- Avoid exposing your arm with the AV fistula to extreme temperatures, such as hot water, ice packs, heating pads, or cold weather. These can affect the blood flow through your AV fistula and cause complications.
- In cold climate – warm gloves can be used for the hand with AV fistula – so as to avoid the cold.
Other Tips
- Keep a record of your AV fistula information, such as when it was created, where it is located, what size needles are used, and any problems you have had with it. This can help you and your dialysis team track the performance and health of your AV fistula.
- Follow a healthy diet and lifestyle that supports your kidney function and overall health.
- Limit salt, fluid, potassium, and phosphorus intake
- Restrict fluid intake strictly
- Take prescribed medications
- Quit smoking
- Keep diabetes and hypertension under control
- Go for walks regularly
- Attend regular check-ups with your vascular specialist who created your AV fistula. He or she will examine your AV fistula and perform tests to assess its function and detect any problems early. He or she may also perform procedures to improve or maintain the blood flow through your AV fistula, such as angioplasty or stenting.
- Dialysis staff can also identify poor blood flow via AV fistula, increase in pressures or any problems while cannulation – always discuss with them whether that warrants a visit to the surgeon for care of the AV fistula.
AV fistula is a lifeline for dialysis. By taking good care of it, one can ensure that the AV fistula works well for a long time. In case you have any questions, or doubts while you are taking care of your AV fistula for your family member, visit our expert doctors for dialysis treatment at NU Hospitals at Bengaluru today.
