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Arteriovenous Fistula for Dialysis Discharge Instructions

Cleaned blood then flows back into your body. This machine is hooked up to a vein in your body. ‚  
Over time, piercing the same vein too often may cause scar tissue to form. There may be more chance for blood clots. At some point, the vein may be destroyed. To keep this from happening and to handle more blood flow, an artery and vein are sewn together to make a fistula. This is called an arteriovenous or AV fistula. Since it may take a few months for the fistula to heal and get stronger, surgery will be needed weeks to months before starting dialysis. ‚  


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What care is needed at home?


  • Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
  • Do not wear anything tight on the fistula arm like watches, tight sleeves, or bracelets.
  • Do not carry anything heavy on the fistula arm like purses, bags, or children.
  • Do not let anyone except a dialysis nurse draw blood from your fistula arm.
  • Do not let anyone take a blood pressure on your fistula arm.
  • If you have any bleeding from the needle site, put direct pressure on right away. If the bleeding doe not stop, go to the ER.
  • Keep doing the hand and arm exercises that you were shown in the hospital.

What follow-up care is needed?


You will be closely watched by healthcare staff during your treatments. Your fistula will be checked at each visit before dialysis is started. ‚  
A dialysis nurse will check for: ‚  
  • Signs of infection including warmth or redness of the skin, swelling of the arm with the fistula, drainage or open sores on the fistula arm
  • Blood flow ¢ ˆ ’ The dialysis nurse will feel your arm for the vibration or "thrill". This happens as blood flows through the fistula. The nurse will use a stethoscope to listen to the sound of the blood going through the fistula. This is called the bruit.

What problems could happen?


  • Infection
  • Blood clot that limits blood flow. If blood clots happen often, you may need a new fistula or the clots may have to be removed.
  • Drainage lasts longer than 48 hours
  • Coldness and pain in the hand (needs care right away)
  • Numbness in the fingers
  • Swelling or bulge at the access site
  • Fistula does not happen
  • Bleeding

When do I need to call the doctor?


  • Signs of infection. These include a fever of 100.4 ‚ °F (38 ‚ °C) or higher, chills, very bad sore throat, ear or sinus pain, cough, more sputum or change in color of sputum, pain with passing urine, mouth sores, or wound that will not heal.
  • Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
  • Pain at the site
  • Coldness or pain in the hand

Teach Back: Helping You Understand


The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing. Before going home, make sure you are able to do these: ‚  
  • I can tell you about my procedure.
  • I can tell you what may help protect my fistula.
  • I can tell you what I will do if I have pain at the site or coldness or pain in my hand.

Where can I learn more?


National Kidney and Urologic Diseases Information Clearinghouse ‚  
http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/ ‚  
National Kidney Foundation ‚  
http://www.kidney.org ‚  
The Kidney Dialysis Foundation ‚  
http://www.kdf.org.sg/ ‚  

Consumer Information Use and Disclaimer


This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. ‚  

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