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AV Fistula Care

Properly caring for your AV fistula can increase the effectiveness of your hemodialysis treatments.
Proper care can also prevent complications.

To care for your AV fistula, you should:

Make sure your nurse or technician checks your access before each hemodialysis treatment.
Keep your access clean at all times.

Use your access site only for dialysis.


Check the pulse in your access every day.

To care for your AV fistula, do not:

Bump or cut your access.


Let anyone put a blood pressure cuff on your access arm.

To care for your AV fistula, also do not:

Wear jewelry or tight clothes over your access site.


Sleep with your access arm under your head or body.
Lift heavy objects or put pressure on your access arm.

How do I take care of my wound when I get home?

If your arm is in a sling, only wear it for the first 24 hours after your surgery. Try to move your arm as
much as is comfortable after that. Follow these steps to take care of your wound:

1. You will have a bandage on your arm. Keep it dry for 48 hours after your surgery. If you need to
shower, wrap your arm in plastic and tape well to keep it dry. Dont take baths until your wound is
healed or your coordinator says its ok. 2. After 48 hours, you can remove the bandage. Wash the area
with mild soap and water. Gently pat this area dry with a towel. Dont use any creams or lotions
over the site. 3. If there are small white tapes under the bandage, leave them in place. It is important to
leave them in place for 1 week or until they fall off. 4. After you take your bandage off, your incision
may ooze clear fluid. If this happens, you may cover it with clean dry gauze. Please change this gauze
as often as needed. 5. Your surgeon used 1 of 2 ways to close your incision (cut made during surgery).
Follow the instructions below for the way your incision was closed.
If you have: Do this: Small tapes (steri strips) and dissolvable sutures Leave the tapes on until they
fall off. This usually happens 7 to 10 days after your surgery. The sutures will dissolve on their own in
about 10 days. Staples or stitches Make an appointment with your co-coordinator to have your staples
taken out 14 days after your surgery. The stitches must stay in place at least 14 days or longer. Do not
have your family doctor remove them.

How will my arm feel?

You may have some pain for a few days. You will get a prescription for Tylenol#3 (acetaminophen
and codeine). Take it as directed to help with the pain. If you have an allergy to this medicine, we will
prescribe you a different one.

AV graft:

Your arm may swell for about 2 weeks after your surgery. This is normal. To reduce the swelling,
keep your arm up when you are resting or sitting. Put it on 2 pillows at the same level as your heart.

AV fistula and AV graft:

Your arm may be cool and numb where the fistula or graft was put in. This lasts a few weeks and is
normal. This will reduce as your circulation gets used to the new fistula or graft.

What about other medicines?

Please talk to your doctor if you stopped a blood thinning medicine before your surgery. They will let
you know when you can start taking it again.

Remember to tell all health care workers that you have an AV fistula or AV graft. Dont use the arm
with your access site for:

taking your blood pressure having blood taken having an intravenous (IV) line put in

How do I care for my fistula or graft?

For both AV fistula and AV graft:

Dont sleep on your access arm. Dont wear tight fitting clothing around your access
arm. Dont put: elastic bands watchbands purses or shopping bags on your access arm.
Dont lift anything that weighs more than 10 pounds with your access arm for the first 3 weeks.
Dont push or pull with the access arm for the first 3 weeks. Never
pick scabs near your graft or fistula needles sites. Dont keep your access arm bent for a long
time. Dont do activities like gardening, jogging or playing sports until your doctor says its ok.

For AV fistula:
Every day, check that you can feel a thrill over your fistula site. A thrill feels like a vibration
or pulse (heart beat). This means your fistula is working well. A nurse will teach you how to do this
after your surgery. Exercise your fistula by squeezing a soft rubber ball. This will help strengthen
it. Wait 2 weeks after your surgery before you start (or after your staples or stitches have been
removed). Squeeze the rubber ball 10 times, 2 to 3 times a day. You do not need to exercise your
graft. It is already the size needed for dialysis.

Call your vascular access coordinator during the day, or go to your nearest emergency department if
you have:

Painful tinglingor numbness in your fingers. Your hand should not be more
painful than your incision (cut) sites. Some numbness and tingling is normal. Severe pain
that does not get better with pain medicine. Seriously injured or hurt your access arm. For example,
if you fell on your arm or cut your skin around the access site. Redness, swelling or pus
(yellowish liquid) from your wound. A lot of bleeding that doesnt stop after putting pressure on
your wound for 15 minutes. A fever higher than 38 C or 100 F.

What about swelling?

Swelling of your arm, hand and fingers (if you had an AV graft placed) is normal. It takes about 2
weeks for the swelling to go down. If you are worried, do this test:

Press on your swollen arm with your finger. If the area you pressed down takes more than a minute to
disappear, call your coordinator or doctor to see your arm.

http://www.surgery.usc.edu/vascular/vascularaccess.html

Potential Complications

Complications that can occur include infection and bleeding. The surgeon should be contacted as soon as
possible for any fever over 100 degrees Farenheit, drainage from the incision or active bleeding. Steal, as
described above, is an uncommon complication.

A potential complication of arteriovenous fistulas is non-maturation. In other words, the vein never enlarges or
becomes thick-walled enough to be used for dialysis. In some cases, causes for non-maturation can be
identified and corrected, allowing maturation to occur.

After a fistula or graft has been in place for a period of time, it may become abnormally large, or develop an
aneurysm. There are procedures that can be performed to correct aneurysmal fistulas.

Arteriovenous fistulas and grafts can develop narrow areas (stenoses) which may decrease the efficiency of
dialysis or put the access at risk for developing a clot. Stenoses can be treated with an operation, or with a
minimally invasive/endovascular approach. (link to minimally invasive and endovascular therapies here.) After
an access has developed a clot, it may or may not be able to be salvaged.

http://kidneyschool.org/m08/8/

http://www.christie.nhs.uk/media/2321/10.pdf

Hugasan ang kamay gamit ang sabon at maligamgam na tubig bago at matapos pangalagaan
ang sugat.
Magsuot ng mask at gloves
Ihanda ang gamit panlinis at pampalit sa dressing
Lagyan ng panlinis na betadine o hydrogen peroxide ang lugar na may sugat gamit ang bulak o
gasa
Pagmasdan
Pagmasdan kung may mga sintomas ng impeksyon ang sugat
Takpan
Takpan ng sterile na gasa ang sugat at tape

Nephro
Nephro Manual by Katrina Gonzales-
Gonzales-Bautista
Nephrocare:
Nephrocare: https://
https://www.nephrocare.com/patients
www.nephrocare.com/patients--home/services/help-
home/services/help-advice.html
Care
Care of your central venous catheter: http://www.christie.nhs.uk/media/232
http://www.christie.nhs.uk/media/2321/10.pdf
1/10.pdf
National
National Kidney Foundation: https://www.kidney.org/atoz/content/hemocatheter
https://www.kidney.org/atoz/content/hemocatheter
http://
http://www.fairview.org/HealthLibrary/Article/116841TGL
www.fairview.org/HealthLibrary/Article/116841TGL
Kidney
Kidney School: http://kidneyschool.org/m08/8/

Hugasan ang kamay gamit ang sabon at maligamgam na tubig bago at matapos
pangalagaan ang sugat.
Magsuot ng mask at gloves
Ihanda ang gamit panlinis at pampalit sa dressing
Lagyan ng panlinis na betadine o hydrogen peroxide ang lugar na may sugat gamit ang bulak o
gasa
Pagmasdan kung may mga sintomas ng impeksyon ang sugat
Takpan ng malinis na gasa ang sugat at tape

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