AV Fistula Placement (Arteriovenous fistula)

What is AV Fistula Placement (Arteriovenous fistula)

AV Fistula placement is a surgical procedure to create a connection between a blood vessel that carries blood away from your heart (artery) and a blood vessel that returns blood to your heart (vein). The connection is called a fistula. It is often made in the forearm or upper arm.

You may need this procedure if you are getting hemodialysis treatments for kidney disease. An AV fistula makes your vein larger and stronger over several months. This makes the vein a safe and easy spot to insert the needles that are used for hemodialysis.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Blood clot (thrombosis).
  • Reduced blood flow (stenosis).
  • Weakening or ballooning out of the fistula (aneurysm).
  • Bleeding.
  • Allergic reactions to medicines.
  • Nerve damage.
  • Swelling near the fistula (lymphedema).
  • Weakening of your heart (congestive heart failure).
  • Failure of the procedure.

What happens before the procedure?

  • Imaging tests of your arm may be done to find the best place for the fistula.
  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
  • Follow instructions from your health care provider about eating or drinking restrictions.
  • You may be given antibiotic medicine to help prevent infection.
  • Ask your health care provider how your surgical site will be marked or identified.
  • Plan to have someone take you home after the procedure.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV tube will be started in one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
    • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • The fistula site will be cleaned with a germ-killing solution (antiseptic).
  • A cut (incision) will be made on the inner side of your arm.
  • A vein and an artery will be opened and connected with stitches (sutures).
  • The incision will be closed with sutures or clips.
  • A bandage (dressing) will be placed over the area.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • Your fistula site will be checked for bleeding or swelling.
  • You will be given pain medication as needed.
  • Do not drive for 24 hours if you received a sedative.

AV Fistula Placement, Care After

These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After your procedure, it is common to:

  • Feel sore.
  • Have numbness.
  • Feel cold.
  • Feel a vibration (thrill) over the fistula.

Follow these instructions at home:

Incision care

  • Do nottake baths or showers, swim, or use a hot tub until your health care provider approves.
  • Keep the area around your cut from surgery (incision) clean and dry.
  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures) and clips in place. They may need to stay in place for 2 weeks or longer.

Fistula Care

  • Check your fistula site every day to make sure the thrill feels the same.
  • Check your fistula site every day for signs of infection. Watch for:
    • Redness.
    • Swelling.
    • Discharge.
    • Tenderness.
    • Enlargement.
  • Keep your arm raised (elevated) while you rest.
  • Do notlift anything that is heavier than a gallon of milk with the arm that has the fistula.
  • Do notlie down on your fistula arm.
  • Do notlet anyone draw blood or take a blood pressure reading on your fistula arm.
  • Do notwear tight jewelry or clothing over your fistula arm.

General instructions

  • Rest at home for a day or two.
  • Gradually start doing your usual activities again. Ask your surgeon when you can return to work or school.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have chills or a fever.
  • You have pain at your fistula site that is not going away.
  • You have numbness or coldness at your fistula site that is not going away.
  • You feel a decrease or a change in the thrill.
  • You have swelling in your arm or hand.
  • You have redness, swelling, discharge, tenderness, or enlargement at your fistula site.

Get help right away if:

  • You are bleeding from your fistula site.
  • You have chest pain.
  • You have trouble breathing.
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