Vascular access for hemodialysis Useful tips

The arteriovenous fistula (AVF) is the most frequent form of vascular access for patients undergoing hemodialysis because it ensures good quality of dialysis. 

  • How should I look after my dialysis access?
  • - After surgery, you should hold the point of the fistula creation over the heart level to reduce swelling and pain.
  • - Hold the cut dry until the sutures are removed and then when bathed do not rub it until it heals completely.
  • - Avoid lifting more than 5 kilos or other activities that can compress the fistula, such as digging.
  • - Report any pain, edema (swelling) or bleeding immediately to your doctor, especially if these symptoms are getting worse. Mild pain or swelling is common and is not something that you should be concerned about if the pain starts to minimize.
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You may initially feel some coldness or numbness in the fistula hand. This sensation usually resolves within a few weeks, as your circulatory system adapts to the fistula function. Nevertheless, if this sensation is intense or does not go away, advise your doctor as soon as possible because the fistula can carry too much blood through the vein that would normally go into your hand, a situation called "steal syndrome".

  • If I proceed with the vascular access, do I automatically need to undergo a dialysis treatment immediately?

Of course not. The creation of the vascular access is made as a preparation, and in no case accelerates the procedure of undergoing a hemodialysis treatment. Instead, it relieves the patient of the inconvenience of the temporary catheter when imperative for the patient to start hemodialysis but the vascular access has not been previously created by a fistula or graft.

  • How can I take care of my AV fistula / AV graft?
  • • Check your access multiple times a day to make sure it is on. You should be able to feel a vibration of the fistula. Your doctor or the staff of the dialysis center will give you instructions on how to do it.
  • • Monitor the access for bleeding after dialysis. If access appears to bleed more than usual from the needle holes, you should inform the staff of the dialysis center.
  • • Do not carry heavy objects with the fistula hand.
  • • Do not sleep at the side of the fistula hand.
  • • Do not wear clothes or jewelry that press the fistula hand.
  • • Do not let anyone take blood or check your blood pressure from the fistula hand.
  • • Do not let anyone give you injections into the fistula or arteriovenous graft.
  • • Keep the point of the fistula or arteriovenous graft clean. Wash it with soap and hot water every day and before each dialysis treatment.
  • • After the dialysis treatment, monitor the access for signs of infection such as swelling or redness.
  • • Do not use creams and lotions above the point of the fistula or thearteriovenousgraft.
  • • The puncture must not be made in the same place each time, but must constantly change position (if of course it is possible).

• In the event of bleeding from the fistula when at home, press with a clear gauze the bleeding point until it stops.

  • What are the precautions about the catheter?
  • • We must assure that the catheter is well attached to the adhesive patches.
  • • The gauze, the bandage and the catheter entry point should always be dry.
  • • If wet (with water / blood) the catheter should be changed (can also be done in a Health Center).
  • • If you notice redness, pain or pus in the catheter's outlet, the dialysis nurse or the nephrologist should be notified immediately.

• For temporary catheters, you can use a scarf, bandana or elastic bandage to keep the catheter in the neck in place.

  • Mesogeios Dialysis Centers Group Scientific Team
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  • Bibliography 
  • 1.  http://www.fistulafirst.org/
  • 2.  KDOQI : Clinical Practice Guidelines for vascular access, update 2006
  • 3.  Arteriovenous anastomosis in hemodialysis patients. A systematic review. Greek Nephrology 2011; 23 (4): 252-267
  • 4. Allon M, Radeva M, Bailey J et al HEMO Study Group. The spectrum of infectionrelated morbidity in hospitalized hemodialysis patients. Nephrol Dial Transpant 2005; 20: 1180-1186
  • 5.  European Best Practice Guidelines for Hemodialysis  NDT,Volume 17, Issue suppl_7
  • 6. Thomas M, Nesbitt C, Ghouri M, Hansrani M. Maintenance of Hemodialysis Vascular Access and Prevention of Access Dysfunction: A Review. Ann Vasc Surg. 2017 Aug;43:318-327. doi: 10.1016/j.avsg.2017.02.014. Epub 2017 May 4. Review.
  • 7. Jemcov TK, Van Biesen W. Optimal timing for vascular access creation. J Vasc Access. 2017 Mar 6;18(Suppl. 1):29-33. doi: 10.5301/jva.5000685. Epub 2017 Mar 5. Review. PubMed PMID: 28297054.
  • 8.  Masengu A, Hanko J. Patient factors and haemodialysis arteriovenous fistula outcomes. J Vasc Access. 2017 Mar 6;18(Suppl. 1):19-23. doi: 10.5301/jva.5000665. Epub 2017 Mar 5. Review. PubMed PMID: 28297052.

9.  Scher LA, Shariff S. Strategies for Hemodialysis Access: A Vascular Surgeon's Perspective. Tech Vasc Interv Radiol. 2017 Mar;20(1):14-19. doi: 10.1053/j.tvir.2016.11.002. Epub 2016 Nov 29. Review. PubMed PMID: 28279404.

 

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