AV fistula for dialysis: why it is planned early and how to care for it
Dr. Joan J. Morales Lappot, MD3 min read · Leer en español
In briefIf hemodialysis may be in your future, one of the most helpful things we can do is plan the access early. The best access for most people is an arteriovenous (AV) fistula.
What a fistula is
A vascular surgeon connects an artery to a vein, usually in the arm. Over the following weeks to months, the extra blood flow makes the vein grow larger and stronger, so it can handle the needles and blood flow dialysis needs. Fistulas last longer and have fewer infections than catheters or grafts.
Why we plan early
A fistula can take two to four months or more to mature. Creating it before dialysis is needed means you can avoid starting with a catheter in the neck or chest, which carries a higher risk of infection. That is also why I ask patients with advanced CKD to protect the veins in their non-dominant arm: no blood draws, IVs or blood pressure cuffs on that side when possible.
- The buzz (thrill) stops or feels different
- The arm is red, warm, swollen or draining
- You have bleeding from the site that will not stop with pressure
- Your hand becomes cold, pale or numb
Caring for your fistula
- Feel for the "thrill," a gentle buzzing vibration, every day
- Keep the arm clean, and wash the site before each treatment
- No blood pressure cuffs, blood draws or tight sleeves or jewelry on that arm
- Do not sleep on that arm or carry heavy bags on it
- Squeeze-ball exercises may help it mature, if your surgeon recommends them