AV Fistula

Questions and Answers about AV (arteriovenous) Fistula
Together, your kidney doctor and you have chosen hemodialysis as the option to treat your renal failure. You have also seen a surgeon or a radiologist to determine which access will work best for you. It has been determined that you should have an AV (arteriovenous) fistula placed. Here are the answers to some commonly asked questions about AV fistulas.

Q: What is an AV fistula?
A: An AV fistula is a dialysis access that is created by connecting an artery to a vein during a short surgery. AV fistulas can be created anywhere from the wrist through the upper arm.

Image reproduced by permission from the Society for Vascular Surgery,
For more information visit www.VascularWeb.org.

Q: Why is an AV fistula necessary?
A: The process of hemodialysis requires that blood pass through an artificial kidney. With a fistula, blood from the arterial side of the fistula passes through a needle into the artificial kidney, is cleaned, and returns to the body through a needle in the venous side. A fistula is useful because arteries are deep in your body and would be difficult to get an access needle into. Veins are closer to the surface of your skin, are easier to see, and are easier to get needles into for hemodialysis.

Q: What happens when an artery is connected to a vein?
A: Arteries have very high blood flow through them. Veins have lower blood flow through them. When an artery is connected to a vein, the vein will “mature”. It will grow in size and expand in order to accept the higher blood flow.

Q: Why is high blood flow through a fistula necessary?
A: The higher the blood flow from your access, the more times your blood will go through the artificial kidney. This will create a more efficient dialysis.

Q: How long will it take for my new AV fistula to “mature”?
A: About 4-6 weeks.

Q: What can I do to help my fistula “mature”?
A: Your doctor or nurse will teach you how to exercise your fistula. However, your fistula will need time to heal before you attempt to exercise it. You can usually start to exercise your fistula about 2 weeks after your surgery.

Q: What happens after my surgery?
A: You will go home and rest for two days. Keep your arm elevated (up on pillows) above your heart for 24 to 48 hours while resting. After two weeks, you can use your arm that has the fistula for routine activity. Just follow the guidelines below.

To care for you AV fistula, follow these instructions:

DO:

• DO examine your fistula everyday by:
  • Listening for “rushing sound”, called a bruit {brew-ee}
  • Feeling for a powerful pulse, called a “thrill”.
• DO call your doctor immediately if:
  • You cannot hear the bruit or feel the thrill, as this could be a sign that the fistula has clotted.
  • You notice redness, swelling or drainage from your fistula.
  • You develop a fever or feel very ill.
• DO keep your fistula clean and dry.
• DO hold light pressure to your needle “sites” after dialysis.

DO NOT:

• DO NOT allow anyone to take blood pressures on your fistula arm.
• DO NOT allow anyone other than dialysis or emergency staff to take blood samples directly from your fistula.
• DO NOT allow blood samples to be drawn anywhere from your fistula arm.
• DO NOT wear tight or restrictive clothing on your fistula arm.
• DO NOT sleep on your fistula arm.
• DO NOT bend your fistula arm for long periods of time.
• DO NOT allow clamps to be placed on your needle “sites” after dialysis if possible.