A fistula is the most commonly used method to remove and return your blood during haemodialysis. It is formed by joining an artery and a vein, usually in the wrist, to allow easier access to your bloodstream. It is normally created before you need to start dialysis so that the vein is larger, stronger and ready for use when you need it. in time, the vein becomes visible under the skin and looks a bit like a varicose vein.
You will usually need to spend the day in hospital for this minor surgical procedure. It is normally performed under local anaesthetic and the procedure lasts about one hour.
There will be a small cut mark at the site of the operation which will be covered in a dressing and a bandage. In time, as this heals, it will leave a small scar.
Immediately after the operation, extra padding and protection may also be placed around the wound site.
The nursing staff will check your dressing regularly after the operation. They will also listen to the buzzing (or ‘bruit’) created by the fistula. This is caused by the turbulent flow of blood in the vein caused by joining it to an artery. In the beginning this will only be heard by using a stethoscope, but in time, you will be able to feel it if you place your hand gently over the fistula.
Sometimes, some blood oozes through the dressing after the operation, but it should not be excessive.
If you require painkillers, these will be given to you.
As you will not be able to drive home, please make arrangements to get home. It is also advisable that you have someone to stay overnight, particularly if you have only been in hospital for the day.
The fistula cannot be used for about 6 weeks. If you need dialysis during this time, you will require a temporary form of access. Having a fistula does not mean that you will start dialysis before you need it. Some people can have their fistula for many months before starting dialysis.
Points to remember after the operation and generally
1. Keep your fistula or graft site and dressing clean and dry.
2. The district nurse will call to check and change the dressing if necessary
3. You should take care with the following activities:
Do not drive for 2 weeks
Avoid sports for at least 2 weeks and ask the doctor in clinic when you can resume these activities
Do not lift heavy objects for 2 weeks and when lifting, be careful not to take the weight of an object on your fistula arm.
4. Once you can feel the buzzing sensation in the fistula or graft, check it at least once a day. If it ever stops contact the hospital immediately.
5. If the fistula/arm shows any signs of infection such as redness, swelling, tenderness and pain contact the hospital immediately.
6. You will receive an outpatients appointment to return to clinic 2 weeks after the operation when the dressing will be removed. the stitches used normally dissolve, but there may be a small knot that needs to be trimmed at this appointment.
7. Never let anyone do the following with your fistula arm:
8. Avoid wearing tight, constrictive clothing and jewellery such as bangles or watches.
9. Do not hang a bag over the arm or carry heavy objects on the fistula arm. This could block off the fistula.