IMPROVING FISTULA DEVELOPMENT

Exercising the arm in which the fistula is created can sometimes help the fistula to develop faster. Ask your nurse or doctor for advice before you start. The picture on the front of this leaflet shows the person exercising using a sponge ball. These are sometimes available from the renal unit but if they have run out any soft ball such as a stress ball will do. Place the ball in the hand of the new fistula. Squeeze the ball by opening and closing your hand for five minutes and then rest for five minutes. Continue this cycle for 30 minutes for at least four times per day. If your arm becomes tired or painful during the exercises, stop and rest your arm.

HOW LONG WILL MY FISTULA LAST?

There is no definite answer to this question. A small number of fistulae never work and you might return from theatre with a failed fistula. Your body is designed to heal itself when it is damaged and sometimes this process can cause the fistula to fail. Another reason can be dehydration before the surgery, which is why some people require a drip before/during surgery. Fistulae can also fail at any stage even after years of use if you become ill or suffer an episode of low blood pressure. Other reasons can be infection, or direct trauma to the fistula, or if something alters how your blood clots. That said, the majority of fistulas work immediately following surgery. You should remember that a successful fistula is less likely than other kinds of vascular accesses to form clots or become infected. Also, fistulas tend to last years longer than any other kind of vascular access.

CARE OF YOUR FISTULA

KNOWN FISTULA COMPLICATIONS

Thrombosis (a blood clot) is the most common cause of fistula failure. Infection is the second most common cause of fistula loss. Arterial steal syndrome The signs and symptoms of steal syndrome are coldness of the fistula hand/fingers, pain or tingling, or poor function of the hand/fingers. This is caused by the fistula diverting too much arterial blood into the vein. The hand then does not receive enough blood supply. If this happens, the fistula can be refashioned surgically. Aneurysm (weakening of the vessel wall) can occur from repeated cannulation of the same fistula site. Large aneurysms limit the available needle sites. The risk can be minimised by carefully rotating the needle sites to allow areas to heal properly between dialysis.

RENAL PATIENT INFORMATION

WHAT IS AN ARTERIOVENOUS FISTULA?
Arterio comes from artery, which is a blood vessel that carries fast-flowing blood that is rich in oxygen to the tissues in the body Venous comes from vein, which is a blood vessel that carries the blood away from the tissues back to the heart to collect more oxygen Fistula is a connection between two structures This means that an Arteriovenous Fistula is an abnormal connection of an artery and a vein. NB. An arteriovenous fistula can also be known as an AV fistula, or fistula, or AVF for short.

WHERE CAN I FIND OUT MORE?

You should talk to the surgeon, doctors and nurses who are managing your care and ask any questions you may still have regarding you fistula. You might find it easier to write down the questions and the answers as it is common to forget what you are told by the time you get home. Dont be afraid to ask a question we will always prefer you to ask rather than worry about it. Shella Sandoval Clinical Nurse Specialist, Renal Vascular Access Royal Free Hospital Pond Street, London NW3 2QG Tel. 020 7794 0500 ext 34893

If you would like a large print or audio version of this information, please ask a member of staff.
Renal department / Patient information programme 2009 [review date: June 2012] www.royalfree.nhs.uk

HOW IS A FISTULA CREATED?

A fistula is created in an operation by joining two of your own blood vessels together. One vessel is an artery and the other is a nearby vein. This new connection (fistula) will build a stronger vein with a larger flow of blood. The pressure of blood is greater inside an artery than inside a vein. Therefore when the surgeon creates the fistula (connection) between the artery and the vein some of the arterial pressure is transferred into the vein. This increased flow of blood through the vein causes it to enlarge, making it suitable for insertion of haemodialysis needles.

needles themselves. Emla cream can also be used but needs to be applied, by you, 45-60minutes before dialysis.

KEEPING YOUR FISTULA WORKING

You play an important part in keeping your fistula healthy because many non-renal staff will not be trained to care for a fistula. You should make all carers aware of the following: Do not take blood pressure measurements on the fistula arm Do not draw any blood tests from the fistula arm No needles for infusions or drips in the fistula arm Do not wear tight restrictive clothing on the fistula arm If you require a vascular catheter (neckline) tell the doctor which arm the fistula is in and ask him to (if possible) protect any blood vessels related to the blood supply of your fistula

BEGINNING TO USE YOUR FISTULA

For the first few weeks your fistula will be adjusting to being needled. During this period the walls of the fistula are quite soft so sometimes the needle may need to be reinserted. This is common and does not mean that the fistula is not working properly. Unfortunately because the vein is now connected to an artery these failed needle sites are prone to moderate bruising. This frequently looks worse than it is because the bruising is just under the surface of the skin and therefore spreads out sideways. Note, as long as your fistula is still working well you need not be concerned about this bruising, as it will slowly go away on its own. If you are concerned ask a member of staff for advice.

WHEN IS A NEW FISTULA READY TO BE USED?

How quickly a fistula develops varies depending on how good the vessels were before the surgery, whether there are any complications, and the general health of the patient. A fistula is ready (or mature) when the vein has grown large enough and strong enough to support the required dialysis needles. This usually takes a minimum of 6-8 weeks but can take much longer in some individuals. Your dialysis nurse will tell you when your fistula is mature.

HOW IS A FISTULA USED FOR DIALYSIS?

The fistula is used for haemodialysis by placing two needles at different places along the fistula. The needles have special tubing attachments, and blood will flow through one needle, called the arterial needle out of the body and to the artificial kidney, and then back into the body through the other venous needle and tubing.

Wash your fistula daily with soap and water and pat dry

HOW DO I KNOW IF MY FISTULA IS WORKING?

Ask your nurse to show you how to check your fistula. Remember it is your lifeline and you must know how to look after it when you are at home. THRILL This is a vibrational feeling when you place your fingers on the skin over your fistula. BRUIT This is the shoosh-shoosh noise your fistula makes when you listen to it through a stethoscope. THREE TIMES A DAY This is how often you should check your fistula during the day.

Avoid sleeping on your fistula arm Do not use sharp objects near your fistula eg razors Avoid carrying heavy loads or shopping with fistula arm Do not remove scabs from needle sites as this can start bleeding or introduce infection Avoid becoming dehydrated as this thickens and slows the blood flow and can clot the fistula (note: you should however stay within your advised fluid restriction) Please note that in an emergency or if other options cannot be found these guidelines may not apply. You should be guided by the medical staff in attendance.

DOES NEEDLE CANNULATION HURT?

Before placing the needles in your fistula the nurse may inject a local anaesthetic which feels like a bee-sting. This will numb the skin and you should not feel any more pain. Many people prefer not to have anaesthetic as some find they dont need it, and others think it hurts more than the