Arterio-Venous Fistula Procedure Guide Patient & Family Education

What is an arteriovenous fistula?

An AV fistula is a connection, made by a vascular surgeon, of an artery to a vein. Arteries carry blood from the heart to the body, while veins carry blood from the body back to the heart.

Vascular surgeons specialize in blood vessel surgery. The surgeon usually places an AV fistula in the forearm or upper arm.

An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible.

Untreated veins cannot withstand repeated needle insertions. They would collapse the way a straw will collapse under strong suction.

Health care providers recommend an AV fistula over the other types of access because it

  • provides good blood flow for dialysis
  • lasts longer than other types of access
  • is less likely to get infected or cause blood clots than other types of access

Before AV fistula surgery, the surgeon may perform a vessel mapping test. Vessel mapping uses Doppler ultrasound to evaluate blood vessels that the surgeon may use to make the AV fistula.

Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider’s office, an outpatient center, or a hospital.

A radiologist or your Vascular Surgeon interprets the images. A patient does not need anesthesia. A Doppler ultrasound shows how much and how quickly blood flows through arteries and veins so the surgeon can select the best blood vessels to use.

A surgeon performs AV fistula surgery in an outpatient center or a hospital. The vascular access procedure may require an overnight stay in the hospital; however, many patients go home afterward. A health care provider uses local anesthesia to numb the area where the surgeon creates the AV fistula.

An AV fistula frequently requires 2 to 3 months to develop, or mature, before the patient can use it for hemodialysis. If an AV fistula fails to mature after surgery, a surgeon must repeat the procedure.

At the start of a hemodialysis session, a health care provider or the patient inserts two needles into the vascular access.
One needle carries blood from the body to the dialyzer. The other carries filtered blood back to the body. To tell the needles apart, the needle that carries blood away from the body is called the arterial needle. The needle that carries blood back to the body is called the venous needle. Some patients prefer to insert their own needles into the vascular access, which requires training to learn how to prevent infection and protect the vascular access.
No matter who inserts the needles, the patient should know how to take care of the needle insertion area to prevent infection.

If an AV fistula does not mature, an AV graft is the second choice for a long-lasting vascular access.

What is an arteriovenous graft?

An AV graft is a looped, plastic tube that connects an artery to a vein. A vascular surgeon performs AV graft surgery, much like AV fistula surgery, in an outpatient center or a hospital. As with AV fistula surgery, the patient may need to stay overnight in the hospital, although many patients can go home after the procedure. A health care provider uses local anesthesia to numb the area where the surgeon creates the AV graft.

A patient can usually use an AV graft 3 – 4 weeks after the surgery. An AV graft is more likely than an AV fistula to have problems with infection and clotting. Repeated blood clots can block the flow of blood through the graft. However, a well-cared-for graft can last several years.

Arteriovenous Fistula/Arteriovenous Graft Discharge Instructions

ACTIVITY

  • Do NOT perform any strenuous activity such as yard work, sports, running, pushing or pulling type activities until you return for our follow-up visit. No lifting over 5 pounds for 2 weeks
    (ex. a half gallon of milk weighs approximately 5 pounds)
  • No driving for at least one week after your surgery. You may ride in a car. Depending on where the incision is located, driving may be difficult for some patients longer than 1 week. You will decide if you have complete range of motion of your arm in order to drive.
  • Do NOT drive while taking prescription pain medications!
  • If your fistula or graft is in the arm:
    Do NOT allow anyone to draw blood or take blood pressures in this arm
    Do not wear tight jewelry or a watch on the arm where the fistula is located.
    Exercise your hand by squeezing a small sponge or “squeezy ball” 10 times every hour while awake.
  • If you smoke – please stop smoking as it increases your chances of developing heart disease, carotid artery disease, lung cancer, and peripheral artery disease. Smoking also delays wound healing.

INCISION CARE

  • It is normal for there to be some redness, swelling, and discomfort for 1-2 weeks after the surgery. There will be a raised ridge along the incision line for several weeks. This is normal.
  • Sometimes we use adhesive glue called Dermabond to close the incision. There are sutures under the skin that will dissolve over time and do not need to come out. The glue is shiny at first. Eventually it will become sticky and darken and begin to peel away.

PAIN

  • Mild incisional discomfort does not require prescription pain medication. For mild discomfort you can take over-the-counter pain medications such as Tylenol (Acetaminophen). Take as directed on the package.
  • You may have been given a prescription for moderate pain. Take it as directed. Pain medications can cause drowsiness and you should not drive while taking prescription pain medications.

PERSONAL HYGIENE/SHOWERS

  • You are allowed to shower the day after your procedure. Do NOT sit down in water for a tub bath, including hot tubs, whirlpool, or swimming pools for 4 weeks until the incision is healed completely.
  • If you have a dressing in place, keep it dry and leave it in place for 48 hours.
  • After 48 hours, gently wash the incisions with antibacterial soap (ex. Dial soap) and water in the shower and pat dry with a clean towel. DO NOT RUB or SCRUB the incision.
  • Make sure to keep the incision clean and dry. Do NOT apply lotions, ointments, creams or powders to the incision.

DIET

  • Resume your previous diet when you return home unless otherwise instructed by your Nephrologist
  • If you have Diabetes, keep your blood glucose levels in good control to help with wound healing

CALL YOUR SURGEON FOR ANY OF THE FOLLOWING SYMPTOMS

  • There is bleeding at the incision that does not stop when pressure is applied
  • You have chills or a fever over 101 degrees
  • The incision has increasing pain, redness, or pus-colored drainage
  • The incision separates
  • If you hand is cold, numb, blue, or painful

FOLLOW UP APPOINTMENT

  • You will follow up with Dr. Walkes in our clinic in 2 weeks after your discharge
  • Due to the nature of Cardiovascular Surgery – you may see our Nurse Practitioner in clinic if Dr. Walkes is in surgery.  Every attempt is made to avoid surgeries on clinic day; however, emergencies and unstable patients are common in the hospital. We appreciate your understanding if this happens when you arrive for your visit
  • We will check your incisions for healing and check the progress of your fistula or graft.
  • If you are already on dialysis: it will most likely be several weeks before your new access site can be used for dialysis.
  • Your Surgeon will tell you when it is okay to begin using it. Continue to use your tunnel catheter for dialysis until then.