FISTULA CARE WHAT YOU SHOULD KNOW:

An arteriovenous fistula also called AVF, is a surgical connection of an artery

directly to a vein. This is usually done in those needing hemodialysis. Hemodialysis is a treatment for acute (sudden) and chronic (long term) kidney failure. It uses a machine that works like the real kidneys to clean waste from your blood. The AVF will act as the bridge for blood to go into the hemodialysis machine. The fistula is usually done on the arm that is not always used (left arm if you are right handed and vice versa). It is where your caregiver puts needles during hemodialysis. Blood will go out from and come back to the AVF after being cleaned by the hemodialysis machine.

Healthy kidneys clean the blood by removing harmful substances like excess

fluid, minerals, and toxic (harmful) wastes. They also make substances that help keep your bones strong and your blood healthy. Kidney failure causes harmful wastes to build up in your body, leading to a rise in your blood pressure. It may also cause your body to retain excess fluid and not make enough red blood cells. When this happens, you may need treatment to replace the work of your failing kidney. Having an AVF for hemodialysis may relieve your symptoms of kidney failure, and improve quality of life.

After Fistula Placement Contact your surgeons or your doctors office and tell their staff if you notice any of the following: -Your incision is swollen, red, warm, or you see pus - these are signs of infection. -Your stitches come apart. -Your bandage becomes soaked with blood. -You develop a high temperature. -The thrill is gone. -A bulging in your access that previously wasnt there. -Your ngers become cold, blue or numb. Exercising your fistula 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. 1. Ball Squeeze 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. Additionally, you may use your other hand to squeeze the bicep of your stula arm. This hinders blood return and causes the stula to dilate because of increased pressure and blood in the vein.

2. Clothes-Pin Grasp Using a clothespin, squeeze open and allow to close repeatedly for 5 minutes, 6 times daily. 3. Finger Tip Touches Another good exercise to help strengthen and develop your stula are nger touch. Touch tips to thumb repeatedly for 5 minutes, 6 times a day. Keeping your fistula clean tip

touches. Touch each nger to the tip of your thumb, opening up your hand after each

Once your AV fistula is strong enough to be used for hemodialysis, it is crucial that you keep it clean. Although a fistula is less prone to infection than other dialysis types, proper hygiene is still important:

Look for redness or swelling around the fistula area. If you experience any pain in the fistula area, tell your doctor immediately. If you get a fever, this can be a sign of infection. Wash and pat dry your fistula arm thoroughly right before each treatment. Your

dialysis facility will provide you with supplies. Proper blood flow through the fistula Blood needs to flow smoothly through your AV fistula. To reduce the risk of blood clots, be careful not to put extra pressure on the area. This may require some changes in your daily habits:

Do not wear tight-fitting shirts. Do not wear jewelry (such as bracelets) that may restrict blood flow on your

access arm.

When carrying things (groceries, bags, luggage), make sure the straps or When having your blood pressure taken or blood drawn, use your non-fistula When sitting or sleeping, make certain that your head, pillow or cushion doesnt

handles dont tighten around your fistula.

arm.

rest on your fistula. Checking your fistula blood flow Check the blood flow through your AV fistula daily. This is done by touch and sound. When you place your fingers over your fistula, you should be able to feel the motion of the blood flowing through it. This sensation is the thrill. Let your doctor know if the thrill ever feels different. To listen for your blood flow, use a stethoscope and place the bell flat on your fistula. The sound you hear is called the bruit (pronounced broo-ee). Any change in the pitch may indicate a clot (thrombolysis) or a narrowing (stenosis) of the fistula. This sound may change from a whooshing noise to a whistle-like sound. -Check the thrill and bruit three times daily.