Dialysis is a treatment recommended for people who have been diagnosed with kidney failure and have little kidney function. The goal of dialysis is to take over some of the kidneys’ vital functions, including filtering waste products and regulating certain chemicals in the blood.
There are two types of dialysis: peritoneal and hemodialysis. Peritoneal dialysis is conducted through a small tube surgically placed in the lower part of your abdomen. Dialysis fluids are regularly introduced into your abdomen and allowed to remain for several hours. Draining the fluid carries away the body’s chemical waste products.
Hemodialysis removes blood through a needle and cleanses it by running it through a dialysis machine. The blood is returned to the body through a second needle.
When patients require long-term hemodialysis, doctors need a method to connect the patient to the dialysis machine to allow the blood to be filtered. There are several options for surgeons to create a connection underneath the skin in a patient’s arm called an AV fistula or AV graft.
When planning for dialysis, you and your doctor should discuss treatment options and decide the best course for you.
What is a Fistula for Dialysis?
Hemodialysis requires access to the blood to allow it to be filtered and cleansed. Since most people need dialysis a few times per week, repeated needle punctures can be very hard on the veins and arteries. Special surgical techniques help create an area that can be used for repeated blood access.
An AV fistula for dialysis helps protect your veins from collapsing during repeated treatments. Arteries carry blood at high pressure away from the heart into every part of the body, while veins collect blood and carry it at low pressure back to the heart.
Attaching the artery to the vein causes the vein to balloon out as high-pressure blood flows directly into it from the artery. About six weeks after this operation, the vein grows tougher and thicker.
When your nephrologist (kidney doctor) determines that dialysis will be necessary in the near future based on multiple factors, such as lab values, they will recommend having the fistula or graft procedure. This is because the fistula can take up to six weeks to mature – meaning it takes that amount of time for the vein to become larger and thicker and be ready for dialysis.
The fistula will be completely under the skin and ready to use on the first day of dialysis. This strategy avoids having to place a temporary dialysis catheter, which has a high risk of infection, failure, and scarring of the patient’s large veins.
Steps Involved in Creating a Dialysis Fistula
An arteriovenous (AV) fistula involves sewing an artery and a vein together below the skin’s surface. This procedure is performed on an outpatient basis with minimal recovery and has a low risk of infection compared to other options. A board-certified vascular surgeon with experience creating fistulas is the best physician to perform the procedure.
Your vascular surgeon will start by having a noninvasive ultrasound before deciding whether you need a fistula or a graft based on the size of your veins. If you are right-handed, the fistula/graft will generally be placed in the opposite arm so you can still use your dominant arm while having dialysis.
An AV fistula is the preferred procedure to create a connection point for dialysis; depending on the patient, an AV graft may be more appropriate. An AV graft for dialysis is an option when the patient’s veins in the arms are too small or scarred to allow for a fistula. The graft is a small synthetic medical-grade tube that allows the patient to have dialysis.
When the AV graft is implanted, two small incisions are made in the forearm (they can also be placed in the upper arm or the thigh if necessary). A tunnel is made under the skin to aid in graft placement. One end of the graft is sewn to the artery and the other to the vein. Blood will then flow rapidly from the artery through the graft into the vein.
Recognize and Manage Common Complications
Once the fistula is placed, it is important to monitor for any complications to ensure it remains available for future dialysis treatments. Here are a few complications to be aware of, although they are rare:
- Swelling, redness, or pus drainage in the area of the fistula
- Fever, body aches, fatigue, or other signs of infection
- No vibration (bruit or thrill) from the graft or fistula, which may mean blood has stopped flowing through it
- A spreading bruise after completion of a dialysis session
- A pulsating hard knot felt under the skin may indicate graft damage because of repeated needle puncturing in the same place
- Coldness, numbness, aching, or weakness of the hand may indicate that not enough blood is flowing through
If you have any of these complications, it is important to speak to your doctor as soon as possible, as it can indicate an infection or malfunction of your fistula or graft.
Essential Tips for Fistula Care and Maintenance
All sanitation procedures must be closely followed when you are having your dialysis treatment. The first step is to ensure the area where the needle will enter your skin is disinfected. The dialysis technologist should wash the site with soap and water and then rub a special antiseptic solution on the area.
Once this has been done, it is important not to touch the area until after dialysis is complete. Remember that the needle breaks the skin, opening a door for infectious bacteria to enter. Absolute cleanliness is required to reduce your chances of infection.
Here are a few other tips to keep in mind when it comes to caring for your AV fistula for dialysis:
- Always make sure your arm is washed and cleaned before your dialysis session.
- Never touch the area where the needle is to enter after skin disinfection or during dialysis.
- Never wear tight sleeves, watches, or bracelets over your graft or fistula.
- Never put pressure against the fistula or graft; avoid carrying heavy loads or sleeping on it.
- Do not allow your blood pressure to be taken in the same arm as your fistula.
- Always apply light pressure to stop bleeding after the dialysis needles are removed. Have the nurse/technologist check to ensure any bleeding stops before you leave the dialysis center.
- Always vary needle puncture sites. Follow a “puncture plan” for advancing needle punctures along the length of the graft before going back to a previous site. This can prevent damage to the fistula and extend its life.
- Never use your graft or fistula for routine blood tests (except during a dialysis session) or intravenous drug treatments.
- Always follow your doctor’s recommendations for maintaining your diet, taking prescription medicines, and exercising regularly.
Long-term Benefits and Enhancements for Dialysis Patients
When patients require long-term dialysis, an AV fistula or AV graft for dialysis is the best method to maintain vein health and allow for connection to the dialysis machine.
If you need an AV fistula for dialysis or an AV graft, our expert team at Empire Vein and Vascular Specialists can help. Our team has performed over 1,157 fistula creations and 523 AV grafts. When you visit us, we can discuss the many long-term options for a fistula or graft for dialysis so you can decide which is best for you. Our board-certified vascular surgeons have extensive expertise in creating fistulas and are the best physicians to perform this type of procedure.
If you would like to learn more about working with Empire Vein and Vascular Specialists to prepare for dialysis, contact our team today for more information about our services.