Q1. What is an arteriovenous fistula (AVF)?
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Q2. Why is it performed?
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Q3. In which part of the body is it performed? Is it visible?
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Q4. Is it a simple procedure?
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Q5. Do I need to stay in the hospital?
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Q6. What medications do I need to take after the procedure?
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Q7. When do I visit the doctor after the procedure?
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Q8. What precautions do I need to take, once the fistula is performed on my arm?
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Q9. When can the fistula be used for haemodialysis?
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Q10. Does the procedure always work?
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Q11. How long does an AV fistula work?
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Q12. Will there be any complications in using the veins in the forearm for haemodialysis?
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Q13. If there is a bleed from the AV fistula site, what should I do?
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Q14. Are there any precautions to be taken prior to the performing of a fistula?
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| Q1. |
What is an arteriovenous fistula (AVF)? |
| A1. |
An AVF is a direct communication between an artery and a vein. It is considered to be an abnormality when it occurs spontaneously
in the body. But for the purposes of haemodialysis, this communication is deliberately performed as a surgery. |
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| Q2. |
Why is it performed? |
| A2. |
During haemodialysis, blood is drawn out of the body, cleaned in the artificial kidney (dialysis machine) and returned to the body.
This amount of blood is a fairly large quantity (around 200 ml per minute) and will not be able to flow in a normal blood vessel.
By creating this short circuit, more arterial blood will flow in the vein and allow the vein to increase in size. It then becomes easy
to puncture this vessel for the purposes of a haemodialysis. |
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| Q3. |
In which part of the body is it performed? Is it visible? top |
| A3. |
The joining of the blood vessels is performed under the skin. Usually, it is a small scar of about 3 to 4 cm. No tubes or needles are
visible on the outside. It is usually performed in the non-dominant arm of the patient, either at the wrist or at the elbow. Once
the wound heals, only a thin scar remains on the skin. Nothing else is visible outside. |
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| Q4. |
Is it a simple procedure? |
| A4. |
Yes. It is usually performed under local anaesthesia and takes around one hour to perform. Only in cases of difficulty does it
take longer. If the blood vessels at the distal part of the forearm or at the wrist are for any reason not suitable, other sites may also
be selected such as the elbow, the upper forearm or the upper arm. |
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| Q5. |
Do I need to stay in the hospital? |
| A5. |
The AVF procedure itself requires no admission. Associated medical conditions may indicate the need for hospitalisation. Sometimes,
if the blood flow following the procedure is not all right, heparinisation may require hospital stay. Otherwise, the patient will be
sent home after a few hours. |
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| Q6. |
What medications do I need to take after the procedure? top |
| A6. |
Generally, a simple antibiotic is prescribed for five days. Other than that, medications prescribed for chronic renal failure will need to
be continued. Suitable painkillers may also be required. |
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| Q7. |
When do I visit the doctor after the procedure? |
| A7. |
The first visit is scheduled two days after the procedure. The wound will be inspected and appropriate instructions will be provided. Sutures are generally removed only after the tenth day. |
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| Q8. |
What precautions do I need to take, once the fistula is performed on my arm? |
| A8. |
Never wear anything tight around the fistula arm, because the blood flow may be blocked. Blood pressure should not be checked
on the same arm. Similarly, no laboratory investigations involving the drawing of blood should be performed in the same
arm. Intramuscular and intravenous injections are also to be avoided on the same arm. Avoid sleeping on the arm or using it to
lift very heavy objects. |
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| Q9. |
When can the fistula be used for haemodialysis? top |
| A9. |
A new fistula takes about 3 to 4 weeks to mature before it can be used for haemodialysis. To facilitate blood flow across the fistula, hand exercises that increase the muscle activity in that arm will be taught. |
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| Q10. |
Does the procedure always work? |
| A10. |
Yes, most of the time. Occasionally, certain conditions may come in the way of a successful surgery – such as if there are very small veins, diabetic changes in the blood vessel or if there have been previous injections or intravenous treatment. You will then need a new fistula to be created at a different site. |
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| Q11. |
How long does an AV fistula work? |
| A11. |
If maintained well, it can work for a lifetime. This depends upon the quality of the blood vessel, episodes of low blood pressure, infection, etc., which can cut short its functioning. |
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| Q12. |
Will there be any complications in using the veins in the forearm for haemodialysis? top |
| A12. |
Yes. Sometimes bleeding and haematoma can occur at the site of the puncture. Rarely, infections can also occur. |
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| Q13. |
If there is a bleed from the AV fistula site, what should I do? |
| A13. |
Immediate compression on the bleeding area, maintained by pressure provided by either a thumb or a tight bandage around the bleeding site is necessary. Pressure anywhere else will only serve to increase bleeding from the fistula site.
Always contact your doctor if you think there is abnormal swelling or sensation at the site of the fistula.
Sudden bleeding can be life-threatening and must therefore not be neglected. |
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| Q14. |
Are there any precautions to be taken prior to the performing of a fistula? |
| A14. |
Once a patient has been diagnosed as having kidney failure, it is important to preserve the non-dominant upper limb so as to make it available for the procedure at a later date. Avoid taking any injections or providing blood samples for laboratory investigations from this upper limb. |
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