Dialysis Services at Guthrie

Dialysis Access

It is very difficult for many patients to believe they will require dialysis treatments in the near future. Patients often ask to wait as long as possible before having their access created. It is imperative for the function of the access and for the comfort future dialysis treatments to have the surgery as many weeks or months before starting dialysis as possible. This gives the access time to develop before dialysis starts, making the dialysis treatments more comfortable with fewer needle complications.

The Arteriovenous Fistula

The fistula is the access of choice for hemodialysis. It has this distinction because it has few complications and usually functions for many years. The fistula is created in the operating room by a vascular surgeon, and is made by joining together an artery and a vein. You do not need to have anesthesia for this surgery. This detour of arterial blood flowing through the vein will cause the vein to get larger and stronger, enabling the dialysis needles to be placed as comfortably as possible.

The Arteriovenous Graft

A graft is another type of access for hemodialysis patients that is appropriate for some patients. The vascular surgeon may offer this type of access if you do not have adequate vessels in your arms to support a fistula. It is also created in the operating room and does not require general anesthesia. A graft is an artificial vein that is used to connect one of your arteries with a vein. This artificial vein creates a detour of your bloodflow. The needles for dialysis are placed in the artificial vein. It is very important that the same sites are not used repeatedly at each dialysis session, but that they are rotated along the length of the graft to decrease the risk of complications.

Care of Your Fistula or Graft

Your surgeon will tell you which arm he plans to place your access in. It is important to make sure that arm is not used for blood pressures, intravenous or drawing bloodwork. After your surgery, keep the dressing clean and dry. Do not allow the incision to become wet for 14 days after the surgery. Do not lift any heavy objects with that arm. One week after your surgery, you should begin to exercise the fistula. This can be done by squeezing a stress ball, a spring-action wrist exerciser or a tennis ball. These exercises should be performed four to five times per day with at least ten repetitions each session. Avoid tight clothing, watches and bracelets on the wrist of your access arm. Try to avoid sleeping on the arm, as the weight of your body can impede the bloodflow through your access. Following the creation of your access, each time you have an appointment with your nephrologist, you will have a brief appointment with one of the dialysis nurses to assess how well your access is maturing.

Access Care:

Keep the wound clean and dry.
Shower or swim only after the sutures are removed.
Protect the affected arm. Avoid tight or restrictive clothing or jewelry on that arm.
Avoid sleeping with the fistula/graft elevated, under your pillow or under your head. This can reduce blood flow through the fistula.
No strenuous exercising or needle punctures in the arm with the fistula/graft. NEVER allow anyone to take blood pressure in that arm.
f the buzzing, pulsation or sound stops, notify your dialysis unit or doctor immediately.
If redness, drainage, tenderness, sudden swelling or any open areas develop, call your dialysis unit or doctor immediately. These can be potential problems and must be treated as soon as possible.
Continued exercising of the fistula/graft will help keep it working.
If the dressing over the fistula becomes soiled or wet, remove the dressing, paint the incision with Betadine and put on a clean gauze with tape.