Materiały źródłowe

• #1 Care of your arteriovenous fistula (AVF) after surgery | CUH

  https://www.cuh.nhs.uk/patient-information/care-of-your-arteriovenous-fistula-avf-after-surgery/

  This leaflet explains how to care for your fistula, which is a join made between an artery (which normally brings blood from your heart) and a vein (which normally returns blood to your heart) in your arm. Your doctor will have discussed your need for a fistula with you. […] You will be seen by a nurse in your renal unit directly after your surgery to check that your wound is healing and that the fistula is working. […] You must know how to look after your fistula when you are at home. Remember that your fistula is your lifeline for dialysis. You should check twice a day that your fistula is working. This is done simply by looking, feeling and listening as follows: Place your fingers on the skin over your fistula; you should feel a vibration (thrill). Listen for the shoosh-shoosh noise (bruit) made by your fistula.

• #2

  https://www.kidney.org.uk/fistula-care

  An arteriovenous fistula, or AVF, is a vessel that is formed by joining a vein to an artery in your arm during an operation to form an accessible blood vessel that gives increased flows of blood that are adequate for dialysis. […] A fistula is the best vascular access for dialysis because it tends to have fewer problems and last longer than other types of dialysis access. […] There are a number of things you should do to protect your fistula. We often call your fistula your lifeline because it is so important in enabling a good dialysis. […] Keep your fistula clean although infections are less likely with a fistula they can still happen. […] Check your fistula daily the nurse will show you how to check for a pulse or vibration through your fistula (called a thrill) or a sound (called a bruit).

• #3

  https://journals.lww.com/cjasn/fulltext/2023/10000/optimizing_arteriovenous_fistula_care_in_kidney.20.aspx

  Arteriovenous fistula (AVF) is the preferred hemo-dialysis access because of its superior durability and lower infection and mortality rates compared with arteriovenous grafts and central venous catheters. […] However, recent evidence indicates that AVF may raise the risk of heart failure through insidious cardiac remodeling with a reported de novo occurrence of 10.2% and 18.3% at 1 and 3 years after kidney transplantation, respectively. […] This practice variation is important because cardiovascular disease is a significant driver of mortality beyond 1 year post-transplant, and even a minor increase in disease burden could have a disproportionate impact on the quality of life and life expectancy of this vulnerable population. […] Randomized controlled trials (RCTs) suggest that fistula ligation may reverse maladaptive cardiac remodeling in kidney transplant recipients.

• #4 AV Graft or Fistula for Permanent Dialysis Access

  https://navicenthealth.org/service-center/atrium-health-navicent-heart-vascular-care/av-graft-or-fistula-for-permanent-dialysis-access

  Dialysis is performed so regularly for some patients, that it makes sense to create a permanent access point for dialysis. This often comes in the form of a fistula, or the joining of an artery and a vein in the arm, that provides a steady flow of blood that can be filtered and processed by the artificial kidney. Arteriovenous fistulas are considered the gold standard for patients who require dialysis on a regular basis. […] The third option is the arteriovenous fistula, deemed the best option by most doctors. Rather than using a plastic tube, a fistula is created by connecting an artery directly to a vein. Once it has matured and grown, a fistula is a natural part of the body and requires less attention and care than an AV graft. A mature fistula that has grown bigger and stronger can provide good blood flow for decades.

• #5 Arteriovenous Fistula (AV Fistula) | University of Utah Health

  https://healthcare.utah.edu/cardiovascular/treatments/arteriovenous-fistula

  An arteriovenous fistula (AV fistula) is a connection created between an artery and a vein. People with end-stage kidney disease often need an AV fistula in their arm as a way to provide access for hemodialysis. […] An arteriovenous fistula is considered the safest, most reliable option. Compared to a catheter or graft, an arteriovenous fistula generally lasts longer and leads to fewer problems, such as clotting and infections. […] If you have surgery to create an AV fistula, the vein will grow wider and thicker, which will allow it to be accessed safely and blood to flow quickly during dialysis. […] People who are having surgery to create an arteriovenous fistula must have an evaluation with a vascular surgery provider beforehand. […] The arteriovenous fistula surgery can take place the day after your evaluation (typically a Wednesday) or at a later time, depending on your preference.

• #6 North Bay Arteriovenous Fistula (AFG) | Vascular Medicine | MarinHealth

  https://www.mymarinhealth.org/programs-services/vascular-surgery/hemodialysis-access/arteriovenous-fistula-avf-/

  Most fistulas are made through a small incision in the upper arm or the forearm. The operation is an outpatient procedure and generally takes less than an hour. […] Before it can be used for dialysis, an AVF must grow enough to handle the dialysis needles. This can take two to three months or more; for this reason, it is recommended to have the AVF surgery done at least several months before dialysis is needed. […] The best long-term dialysis access is an arteriovenous fistula because it uses all-natural tissue and therefore can last longer and is more resistant to infection and clotting. However, this requires that the patient have a good arm vein to use for the fistula. This can be determined by an ultrasound of the veins (vein mapping) before surgery to look at the size of the veins, and any sign of damage from previous blood draws or IV catheters.

• #7 Having an arteriovenous fistula formed – Looking after your arteriovenous fistula or graft | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/having-arteriovenous-fistula-formed/looking-after-your-arteriovenous-fistula-or

  If you are having haemodialysis treatment, dialysis nurses will need to have access to your blood stream and veins. This is called vascular access. […] An AVF is formed during an operation. An artery (a blood vessel carrying blood from the heart around the body) is connected to a vein (a blood vessel carrying blood back to the heart). This is usually done at the wrist or elbow. This causes more blood to flow through the vein, which helps the vein grow larger and stronger. This makes it possible to repeatedly insert the needles needed for haemodialysis treatment. […] Check your fistula or graft each day for a buzzing sensation known as a thrill. This thrill is caused by the high flow of blood through the fistula or graft, and is a sign that it is working well. If you do not know how to check for the thrill, please ask the nurses looking after you. If you cannot feel the thrill, let your nursing team know immediately.

• #8 Care of your arteriovenous fistula after surgery

  https://leaflets.ekhuft.nhs.uk/care-of-your-arteriovenous-fistula-after-surgery/html/

  Do not wear any tight or restrictive clothing on your fistula arm. […] Avoid sleeping on your fistula arm. […] Do not use sharp objects near your fistula arm, for example razors. […] Avoid carrying heavy loads or shopping bags directly over your fistula. […] Do not remove the scabs from the needle sites, as this may cause bleeding or an infection. […] You will be seen by a nurse in your nearest Renal Unit one week after your surgery, to check your wound is healing and your fistula is working. […] A fistula can take up to six to eight weeks to mature ready for haemodialysis. […] Exercising the arm in which the fistula is created can sometimes help the fistula to develop faster. […] If you are worried about any of the above, please call us for advice. […] A fistula is ready, or mature, when your vein has grown large enough and strong enough to support the required dialysis needles.

• #9

  https://medschool.cuanschutz.edu/surgery/divisions-centers-affiliates/transplant/patient-care/dialysis-access-surgery/hemodialysis

  Patients that are on, or plan to start, hemodialysis have better short- and long-term outcomes if they receive dialysis through a arteriovenous fistula. […] The creation of an arteriovenous fistula, in which an artery and vein are surgically connected to each other, takes place in an outpatient surgical setting. […] Once the operation is complete, it takes an average of 6-8 weeks for the vein to grow or mature enough to be usable for hemodialysis. […] Arteriovenous fistulas can take between 6-12 weeks to mature and arteriovenous grafts can generally be used 2-3 weeks after surgery. […] It’s important to perform forearm exercises with the aid of a stress ball. You should squeeze and release the ball rapidly for 10 minutes 6 times per day. […] The recovery room nurse will give you a stethoscope after surgery. You should be able to hear the bruit and feel the thrill of the fistula. If at any time you cannot hear the bruit or feel the thrill of your fistula, please call our office.

• #10 Arteriovenous Fistula Care for Patients Undergoing Hemodialysis

  https://www.asterhospitals.in/blogs-events-news/aster-rv-bangalore/arteriovenous-fistula-care-patients-hemodialysis

  Arteriovenous Fistula care in Patients on Hemodialysis […] Dos and Donts after AV fistula surgery: […] Keep the wound clean till it heals which might take 10 to 14 days. […] Start exercising the fistula hand by squeezing the sponge ball, 2 to 3 days after the surgery after the resolution of pain and swelling. […] Feel the thrill (vibration) by placing your fingers on the skin over the fistula at least two times a day. If it stops, seek medical help immediately. […] How much time it will take for the AV fistula to mature? […] It will take around six weeks for the fistula to mature. In some patients, we can use it early and in some, it might take long time to mature. A good fistula should have a diameter of 6mm and length of 6 cms. […] What are the complications of AV fistula? […] Infection can happen immediately after the surgery or later, but it is very rare. […] Thrombosis: Clots can happen in the AV fistula. Commonly happens if the blood pressure drops during or after the hemodialysis. […] Arterial steal phenomenon: Some patients can experience cold, numbness and pain in the fingers on the fistula hand. […] Aneurysms: Bulge in the hands over the course of AV fistula is seen when it is used for many years.

• #11 Care of your arteriovenous fistula (AVF) after surgery | CUH

  https://www.cuh.nhs.uk/patient-information/care-of-your-arteriovenous-fistula-avf-after-surgery/

  You play an important part in keeping your fistula healthy. Do not take blood pressure measurements from your fistula arm. Do not have any blood tests taken from your fistula arm. No needles, infusions, or drips are to go into your fistula arm. Do not wear any tight or restrictive clothing on your fistula arm. Avoid sleeping on your fistula arm. Do not use sharp objects near your fistula arm, for example razors. Avoid carrying heavy loads or shopping bags directly over your fistula. Do not remove scabs from the needle sites; this may cause bleeding or infection. A fistula wristband will be provided. […] Exercising your arm in which the fistula is created can help it to develop more quickly. You will be given a sponge ball to use to help with your fistula development. Place the ball in the hand with the fistula. Squeeze the ball repeatedly for five to 10 minutes; repeat this two to three times a day. If your arm becomes tired or painful during the exercises, stop and rest it.

• #12 Arteriovenous Fistula Care for Patients Undergoing Hemodialysis

  https://www.asterhospitals.in/blogs-events-news/aster-rv-bangalore/arteriovenous-fistula-care-patients-hemodialysis

  Arteriovenous Fistula care in Patients on Hemodialysis […] Dos and Donts after AV fistula surgery: […] Keep the wound clean till it heals which might take 10 to 14 days. […] Start exercising the fistula hand by squeezing the sponge ball, 2 to 3 days after the surgery after the resolution of pain and swelling. […] Feel the thrill (vibration) by placing your fingers on the skin over the fistula at least two times a day. If it stops, seek medical help immediately. […] How much time it will take for the AV fistula to mature? […] It will take around six weeks for the fistula to mature. In some patients, we can use it early and in some, it might take long time to mature. A good fistula should have a diameter of 6mm and length of 6 cms. […] What are the complications of AV fistula? […] Infection can happen immediately after the surgery or later, but it is very rare. […] Thrombosis: Clots can happen in the AV fistula. Commonly happens if the blood pressure drops during or after the hemodialysis. […] Arterial steal phenomenon: Some patients can experience cold, numbness and pain in the fingers on the fistula hand. […] Aneurysms: Bulge in the hands over the course of AV fistula is seen when it is used for many years.

• #13

  https://childrenswi.org/publications/teaching-sheet/dialysis/1046-arteriovenous-fistula-or-graft

  Your doctor or nurse will talk to you about what exercises to do and when to start. Often, you will start them about one week after surgery. If there were any problems with the surgery, it might be longer. Exercises should be done 3 to 4 times a day on days when you do not have hemodialysis. You should do them until your fistula has good blood flow. Your dialysis nurse will tell you when you can stop doing them.

• #14 Care of your arteriovenous fistula (AVF) after surgery | CUH

  https://www.cuh.nhs.uk/patient-information/care-of-your-arteriovenous-fistula-avf-after-surgery/

  You play an important part in keeping your fistula healthy. Do not take blood pressure measurements from your fistula arm. Do not have any blood tests taken from your fistula arm. No needles, infusions, or drips are to go into your fistula arm. Do not wear any tight or restrictive clothing on your fistula arm. Avoid sleeping on your fistula arm. Do not use sharp objects near your fistula arm, for example razors. Avoid carrying heavy loads or shopping bags directly over your fistula. Do not remove scabs from the needle sites; this may cause bleeding or infection. A fistula wristband will be provided. […] Exercising your arm in which the fistula is created can help it to develop more quickly. You will be given a sponge ball to use to help with your fistula development. Place the ball in the hand with the fistula. Squeeze the ball repeatedly for five to 10 minutes; repeat this two to three times a day. If your arm becomes tired or painful during the exercises, stop and rest it.

• #15

  https://www.kidney.org.uk/fistula-care

  An arteriovenous fistula, or AVF, is a vessel that is formed by joining a vein to an artery in your arm during an operation to form an accessible blood vessel that gives increased flows of blood that are adequate for dialysis. […] A fistula is the best vascular access for dialysis because it tends to have fewer problems and last longer than other types of dialysis access. […] There are a number of things you should do to protect your fistula. We often call your fistula your lifeline because it is so important in enabling a good dialysis. […] Keep your fistula clean although infections are less likely with a fistula they can still happen. […] Check your fistula daily the nurse will show you how to check for a pulse or vibration through your fistula (called a thrill) or a sound (called a bruit).

• #16 Understanding the Arteriovenous Fistula | Azura Vascular Care azura-logo-white

  https://www.azuravascularcare.com/infodialysisaccess/arteriovenous-fistula/

  An arteriovenous fistula requires daily inspection and care. You need to clean it every day with antimicrobial soap and water, and you’ll want to avoid sleeping on it. You need to look, listen and feel for signs that your AV fistula is functioning properly. […] Look – Look at your access to check for signs of infection – swelling, redness, warmth and drainage are all signs to watch for. Also note if there are any changes to the skin, such as bleeding, bulging or peeling. […] Listen – Put your ear to your arm (or leg) and listen for the sound of blood flowing through your fistula. […] Feel – Put your hand on your access to feel the “thrill.” Any change in the feel of the vibration, or an absence of vibration is cause for concern. If there is no vibration or thrill you should notify your doctor immediately. […] Taking care of your AV fistula is critical. Your dialysis access is your lifeline to good health, and with proper care once it’s fully mature, you can expect your AV fistula to continue to function well.

• #17 Arteriovenous Fistula

  https://smmc.sx/Patient-Care/Patient-Information/General-Surgery/Arteriovenous-Fistula

  Check for fistula function at least twice a day. This is done by placing 2 fingers over the operation site and feeling for a buzz sensation. […] Keep skin clean. Check for signs of infection swelling, redness, and soreness. […] Exercise fistula arm to help improve the blood flow squeeze a squash ball 10 times an hour at least 48hrs after the operation. […] Elevate the arm if swelling is present after the operation. […] Do not restrict the blood flow to your fistula. Avoid wearing watches, jewelry and tight sleeves on arm. […] Do not sleep or put pressure on your fistula arm. […] Do not lift heavy (more than 1kg) objects for 6 weeks. […] Do not allow blood pressure, blood sampling and IV cannula insertion on the fistula arm.

• #18 Haemodialysis access with an arteriovenous fistula | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/treatments/vascular-access-for-dialysis/patient-info-haemodialysis-access-with-an-arteriovenous-fistula/

  Avoid pressure. Try to avoid lifting heavy objects which may put pressure on your fistula arm. Try not to sleep on that side of your body, too. […] Check it every day. Your kidney team will show you how to check for a vibration through your fistula (called a thrill or a buzz). If you don’t feel this, contact your kidney team straight away as the fistula may be blocked. […] Avoid having your blood pressure taken from your fistula arm as this could damage your fistula. […] Contact your kidney team straight away if your fistula feels hot, swollen or is causing you pain. […] Contact your kidney team immediately if you notice that your fistula’s normal vibration or thrill has stopped. […] If there is any bleeding from your fistula in between dialysis sessions, you need to get help immediately. Use a bottle top to cover the bleeding site and keep it firmly in place until you receive medical help.

• #19

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Maintaining vascular access for hemodialysis […] For the most effective hemodialysis, the patient needs good vascular access with an arteriovenous (AV) fistula or an AV graft that provides adequate blood flow. […] Follow your facility’s policies and procedures and these clinical tips to protect and preserve the vascular access and avoid complications such as infection, stenosis, thrombosis, and hemorrhage: […] Perform hand hygiene before you assess or touch the vascular access. If it’s a new vascular access with a wound, don gloves. Position the patient’s arm so the vascular access is easily visualized. […] Assess for patency at least every 8 hours. […] Palpate the vascular access to feel for a thrill or vibration that indicates arterial and venous blood flow and patency. […] Auscultate the vascular access with a stethoscope to detect a bruit or „swishing” sound that indicates patency.

• #20

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Maintaining vascular access for hemodialysis […] For the most effective hemodialysis, the patient needs good vascular access with an arteriovenous (AV) fistula or an AV graft that provides adequate blood flow. […] Follow your facility’s policies and procedures and these clinical tips to protect and preserve the vascular access and avoid complications such as infection, stenosis, thrombosis, and hemorrhage: […] Perform hand hygiene before you assess or touch the vascular access. If it’s a new vascular access with a wound, don gloves. Position the patient’s arm so the vascular access is easily visualized. […] Assess for patency at least every 8 hours. […] Palpate the vascular access to feel for a thrill or vibration that indicates arterial and venous blood flow and patency. […] Auscultate the vascular access with a stethoscope to detect a bruit or „swishing” sound that indicates patency.

• #21 Haemodialysis access with an arteriovenous fistula | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/treatments/vascular-access-for-dialysis/patient-info-haemodialysis-access-with-an-arteriovenous-fistula/

  Avoid pressure. Try to avoid lifting heavy objects which may put pressure on your fistula arm. Try not to sleep on that side of your body, too. […] Check it every day. Your kidney team will show you how to check for a vibration through your fistula (called a thrill or a buzz). If you don’t feel this, contact your kidney team straight away as the fistula may be blocked. […] Avoid having your blood pressure taken from your fistula arm as this could damage your fistula. […] Contact your kidney team straight away if your fistula feels hot, swollen or is causing you pain. […] Contact your kidney team immediately if you notice that your fistula’s normal vibration or thrill has stopped. […] If there is any bleeding from your fistula in between dialysis sessions, you need to get help immediately. Use a bottle top to cover the bleeding site and keep it firmly in place until you receive medical help.

• #22 Nephrocare – Access care

  https://www.nephrocare.com/patients-home/living-with-dialysis/access-care

  Your fistula is your lifeline and you can play an active role in keeping it in good condition. […] Of course every patient’s fistula is different and may require different care. […] Given that the fistula plays a key role in a successful dialysis treatment, it is really important to keep it in good condition. Your fistula needs checking every day! You should use your eyes, ears and fingers to check that everything is OK. […] If you notice any of these disturbing symptoms: redness, swelling, soreness, increased temperature in the fistula area, please contact your doctor or dialysis team immediately. […] In order to avoid any possible bacteria migrations from the skin to the blood circulation system, which could lead to infection, always remember to: Wash the access site with water and soap reserved for that purpose only every day and before each dialysis session.

• #23 Care of your arteriovenous fistula after surgery

  https://leaflets.ekhuft.nhs.uk/care-of-your-arteriovenous-fistula-after-surgery/html/

  Your wound will take 10 to 14 days to heal. […] We advise you to keep your dressing dry for at least three days before you change it. You will be given spare dressings to take home. […] Keep your wound covered for seven days. […] Avoid any heavy lifting / pressure with your fistula arm for two weeks. […] Do not keep your fistula arm bent for long periods of time. […] Most patients will have dissolvable sutures. We will tell you if stitches / clips need to be removed. […] You must know how to look after it when you are at home. […] Twice a day is how often you should check your fistula. […] Do not take blood pressure measurements from your fistula arm. […] Do not have any blood tests taken from your fistula arm. […] No needles, infusions, or drips go in your fistula arm.

• #24 Care of your arteriovenous fistula (AVF) after surgery | CUH

  https://www.cuh.nhs.uk/patient-information/care-of-your-arteriovenous-fistula-avf-after-surgery/

  You play an important part in keeping your fistula healthy. Do not take blood pressure measurements from your fistula arm. Do not have any blood tests taken from your fistula arm. No needles, infusions, or drips are to go into your fistula arm. Do not wear any tight or restrictive clothing on your fistula arm. Avoid sleeping on your fistula arm. Do not use sharp objects near your fistula arm, for example razors. Avoid carrying heavy loads or shopping bags directly over your fistula. Do not remove scabs from the needle sites; this may cause bleeding or infection. A fistula wristband will be provided. […] Exercising your arm in which the fistula is created can help it to develop more quickly. You will be given a sponge ball to use to help with your fistula development. Place the ball in the hand with the fistula. Squeeze the ball repeatedly for five to 10 minutes; repeat this two to three times a day. If your arm becomes tired or painful during the exercises, stop and rest it.

• #25 Haemodialysis access with an arteriovenous fistula | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/treatments/vascular-access-for-dialysis/patient-info-haemodialysis-access-with-an-arteriovenous-fistula/

  Avoid pressure. Try to avoid lifting heavy objects which may put pressure on your fistula arm. Try not to sleep on that side of your body, too. […] Check it every day. Your kidney team will show you how to check for a vibration through your fistula (called a thrill or a buzz). If you don’t feel this, contact your kidney team straight away as the fistula may be blocked. […] Avoid having your blood pressure taken from your fistula arm as this could damage your fistula. […] Contact your kidney team straight away if your fistula feels hot, swollen or is causing you pain. […] Contact your kidney team immediately if you notice that your fistula’s normal vibration or thrill has stopped. […] If there is any bleeding from your fistula in between dialysis sessions, you need to get help immediately. Use a bottle top to cover the bleeding site and keep it firmly in place until you receive medical help.

• #26

  https://www.kidney.org.uk/fistula-care

  Do not let anything obstruct the blood flow in your arm do not allow your blood pressure to be taken on your fistula arm and do not wear constricting clothes or jewellery. […] Generally you should avoid allowing anyone to take blood from your fistula arm when you are not on dialysis. […] Never allow a cannula to be inserted into your fistula for administration of drugs or IV fluids. […] Try not to scratch your fistula or do anything which can cause an injury to it. […] Nurses will support you in inserting your own needles if you wish. […] After dialysis the nurse (or yourself/carer if you have received training) will remove your needles and will encourage you to apply pressure on the needle puncture site to stop it from bleeding. […] Although a fistula is the best sort of access and is least likely to develop problems, you do need to be aware of problems that can occur so they can be acted upon quickly.

• #27 Nephrocare – Access care

  https://www.nephrocare.com/patients-home/living-with-dialysis/access-care

  Avoid activities that might cause injuries to the fistula such as lifting heavy objects like suitcases or packing cases. […] Very high or low temperatures can also have adverse effects on your fistula and lead to thrombosis. It is recommendable not to expose yourself to: Excessive heat (e.g. sauna or sweat baths), as it induces vessel dilation and reduces the blood pressure and blood flow. […] CVC care is usually done by nurses. The catheter exit site should be cleaned during each dialysis treatment.

• #28 Arteriovenous Fistula (AV Fistula) | University of Utah Health

  https://healthcare.utah.edu/cardiovascular/treatments/arteriovenous-fistula

  The incision site should heal within one to two weeks. Be sure to watch for signs of infection, such as pain, redness, swelling, or fever. […] Before using the AV fistula, a vascular surgery provider will need to see you in the clinic to make sure that the AV fistula has matured. […] The care team teaches you how to protect your AV fistula. The following are some key things to remember to avoid any complications after your procedure: Keep the AV fistula area clean at all times. Be careful not to bump or injure the area. Watch for signs of infection. Don’t sleep with the access arm under your head or body. Don’t carry heavy objects on your fistula arm. Don’t wear tight sleeves or jewelry on the access arm. Don’t allow blood pressures to be taken on your fistula arm. […] If you notice any problems or have concerns, contact your vascular surgeons office right away.

• #29 Arteriovenous Fistula

  https://smmc.sx/Patient-Care/Patient-Information/General-Surgery/Arteriovenous-Fistula

  Check for fistula function at least twice a day. This is done by placing 2 fingers over the operation site and feeling for a buzz sensation. […] Keep skin clean. Check for signs of infection swelling, redness, and soreness. […] Exercise fistula arm to help improve the blood flow squeeze a squash ball 10 times an hour at least 48hrs after the operation. […] Elevate the arm if swelling is present after the operation. […] Do not restrict the blood flow to your fistula. Avoid wearing watches, jewelry and tight sleeves on arm. […] Do not sleep or put pressure on your fistula arm. […] Do not lift heavy (more than 1kg) objects for 6 weeks. […] Do not allow blood pressure, blood sampling and IV cannula insertion on the fistula arm.

• #30 Dialysis Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559085/

  Dialysis fistula creation is a commonly performed procedure for patients who suffer from the end-stage renal disease who require permanent vascular access for hemodialysis. Arteriovenous fistulas are the preferred initial access compared to prosthetic grafts or hemodialysis catheters. […] This activity outlines the preparation and complications of dialysis fistula creation and highlights the role of the interprofessional team in evaluating and managing dialysis fistulas. […] Dialysis nurses also play a critical role in evaluating and managing dialysis fistulas. Dialysis nurses can report arteriovenous fistula malfunction during dialysis, such as decreased flow rates (possible inflow or outflow obstruction), delayed hemostasis at needle puncture sites (possible outflow obstruction), or erythema and drainage overlying the fistula site (possible infection). […] Understanding complications such as ischemic steal syndrome and patients complaining of numbness or tingling after dialysis can prompt nurses to call surgical services sooner.

• #31

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Maintaining vascular access for hemodialysis […] For the most effective hemodialysis, the patient needs good vascular access with an arteriovenous (AV) fistula or an AV graft that provides adequate blood flow. […] Follow your facility’s policies and procedures and these clinical tips to protect and preserve the vascular access and avoid complications such as infection, stenosis, thrombosis, and hemorrhage: […] Perform hand hygiene before you assess or touch the vascular access. If it’s a new vascular access with a wound, don gloves. Position the patient’s arm so the vascular access is easily visualized. […] Assess for patency at least every 8 hours. […] Palpate the vascular access to feel for a thrill or vibration that indicates arterial and venous blood flow and patency. […] Auscultate the vascular access with a stethoscope to detect a bruit or „swishing” sound that indicates patency.

• #32

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Assess the vascular access for signs and symptoms of infection such as redness, warmth, tenderness, purulent drainage, open sores, or swelling. Patients with end-stage kidney disease are at increased risk of infection. […] After dialysis, assess the vascular access for any bleeding or hemorrhage. […] Assess for blebs (ballooning or bulging) of the vascular access that may indicate an aneurysm that can rupture and cause hemorrhage. […] Teach the patient: to make sure that dialysis needlestick locations are rotated to prevent stenosis and thrombus formation, to check the function of the vascular access several times a day by palpating it and feeling for vibration, to monitor for any bleeding after dialysis, to monitor for signs of infection, to keep the site clean, to avoid wearing any clothing or jewelry that restricts the access and to prevent anyone from using the extremity to obtain BP or perform venipuncture, not to use the arm with vascular access to carry heavy objects and not to sleep on the arm, not to use any creams and lotions on the vascular access site. […] Document assessment findings, any interventions and patient responses, patient teaching, and the patient’s level of understanding.

• #33

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Assess the vascular access for signs and symptoms of infection such as redness, warmth, tenderness, purulent drainage, open sores, or swelling. Patients with end-stage kidney disease are at increased risk of infection. […] After dialysis, assess the vascular access for any bleeding or hemorrhage. […] Assess for blebs (ballooning or bulging) of the vascular access that may indicate an aneurysm that can rupture and cause hemorrhage. […] Teach the patient: to make sure that dialysis needlestick locations are rotated to prevent stenosis and thrombus formation, to check the function of the vascular access several times a day by palpating it and feeling for vibration, to monitor for any bleeding after dialysis, to monitor for signs of infection, to keep the site clean, to avoid wearing any clothing or jewelry that restricts the access and to prevent anyone from using the extremity to obtain BP or perform venipuncture, not to use the arm with vascular access to carry heavy objects and not to sleep on the arm, not to use any creams and lotions on the vascular access site. […] Document assessment findings, any interventions and patient responses, patient teaching, and the patient’s level of understanding.

• #34 Nursing care the arteriovenous fistulas: literature review

  https://www.nucleodoconhecimento.com.br/health/nursing-care

  The patient must be guided by nursing and need to implement some care with the fistula, among which include: perform daily exercise with rubber ball compression for fifteen minutes three times a day helps keep the fistula; observe any change in the location of the fistula, as heat, pain, Erythema, and swelling, palpation and perception of the thrill (vibration noticeable due to arterial blood mix with deoxygenated blood), any abnormality should be reported medical and nursing teams; avoid venous puncture and check blood pressure in the arm of the fistula; avoid checking blood pressure in this member, sleeping on the arm of access and any compression, should not remove or allow removal of hair and scabs formed in the region of the fistula. […] Customer care in haemodialysis should be done by a nurse with specialty and must receive constant training in this area because it is an impaired with low immune resistance and susceptible to several complications of arteriovenous Fistulas.

• #35

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Assess the vascular access for signs and symptoms of infection such as redness, warmth, tenderness, purulent drainage, open sores, or swelling. Patients with end-stage kidney disease are at increased risk of infection. […] After dialysis, assess the vascular access for any bleeding or hemorrhage. […] Assess for blebs (ballooning or bulging) of the vascular access that may indicate an aneurysm that can rupture and cause hemorrhage. […] Teach the patient: to make sure that dialysis needlestick locations are rotated to prevent stenosis and thrombus formation, to check the function of the vascular access several times a day by palpating it and feeling for vibration, to monitor for any bleeding after dialysis, to monitor for signs of infection, to keep the site clean, to avoid wearing any clothing or jewelry that restricts the access and to prevent anyone from using the extremity to obtain BP or perform venipuncture, not to use the arm with vascular access to carry heavy objects and not to sleep on the arm, not to use any creams and lotions on the vascular access site. […] Document assessment findings, any interventions and patient responses, patient teaching, and the patient’s level of understanding.

• #36

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Maintaining vascular access for hemodialysis […] For the most effective hemodialysis, the patient needs good vascular access with an arteriovenous (AV) fistula or an AV graft that provides adequate blood flow. […] Follow your facility’s policies and procedures and these clinical tips to protect and preserve the vascular access and avoid complications such as infection, stenosis, thrombosis, and hemorrhage: […] Perform hand hygiene before you assess or touch the vascular access. If it’s a new vascular access with a wound, don gloves. Position the patient’s arm so the vascular access is easily visualized. […] Assess for patency at least every 8 hours. […] Palpate the vascular access to feel for a thrill or vibration that indicates arterial and venous blood flow and patency. […] Auscultate the vascular access with a stethoscope to detect a bruit or „swishing” sound that indicates patency.

• #37 AV Fistula Care Before, During & After Dialysis

  https://www.drsumitkapadia.com/blog/care-of-your-arteriovenous-fistula-avf-before-during-after-dialysis/

  Always inform the nursing staff about your AV fistula. Provide them with information regarding its location and status to ensure proper handling during dialysis. […] After dialysis, allow your arm some downtime. Avoid using the arm with the AVF for heavy lifting or activities for at least a few hours. […] Gently wash the fistula site with soap and water and pat it dry. Avoid applying creams or lotions to the area until your healthcare provider clears it. […] Look for signs of infection, such as redness, swelling, or discharge at the site. If you notice any of these symptoms, seek medical advice immediately. […] Schedule regular appointments with your vascular specialist to monitor the condition of your AV fistula.

• #38

  https://www.kidney.org.uk/fistula-care

  Do not let anything obstruct the blood flow in your arm do not allow your blood pressure to be taken on your fistula arm and do not wear constricting clothes or jewellery. […] Generally you should avoid allowing anyone to take blood from your fistula arm when you are not on dialysis. […] Never allow a cannula to be inserted into your fistula for administration of drugs or IV fluids. […] Try not to scratch your fistula or do anything which can cause an injury to it. […] Nurses will support you in inserting your own needles if you wish. […] After dialysis the nurse (or yourself/carer if you have received training) will remove your needles and will encourage you to apply pressure on the needle puncture site to stop it from bleeding. […] Although a fistula is the best sort of access and is least likely to develop problems, you do need to be aware of problems that can occur so they can be acted upon quickly.

• #39

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Assess the vascular access for signs and symptoms of infection such as redness, warmth, tenderness, purulent drainage, open sores, or swelling. Patients with end-stage kidney disease are at increased risk of infection. […] After dialysis, assess the vascular access for any bleeding or hemorrhage. […] Assess for blebs (ballooning or bulging) of the vascular access that may indicate an aneurysm that can rupture and cause hemorrhage. […] Teach the patient: to make sure that dialysis needlestick locations are rotated to prevent stenosis and thrombus formation, to check the function of the vascular access several times a day by palpating it and feeling for vibration, to monitor for any bleeding after dialysis, to monitor for signs of infection, to keep the site clean, to avoid wearing any clothing or jewelry that restricts the access and to prevent anyone from using the extremity to obtain BP or perform venipuncture, not to use the arm with vascular access to carry heavy objects and not to sleep on the arm, not to use any creams and lotions on the vascular access site. […] Document assessment findings, any interventions and patient responses, patient teaching, and the patient’s level of understanding.

• #40

  https://www.kidney.org.uk/fistula-care

  Do not let anything obstruct the blood flow in your arm do not allow your blood pressure to be taken on your fistula arm and do not wear constricting clothes or jewellery. […] Generally you should avoid allowing anyone to take blood from your fistula arm when you are not on dialysis. […] Never allow a cannula to be inserted into your fistula for administration of drugs or IV fluids. […] Try not to scratch your fistula or do anything which can cause an injury to it. […] Nurses will support you in inserting your own needles if you wish. […] After dialysis the nurse (or yourself/carer if you have received training) will remove your needles and will encourage you to apply pressure on the needle puncture site to stop it from bleeding. […] Although a fistula is the best sort of access and is least likely to develop problems, you do need to be aware of problems that can occur so they can be acted upon quickly.

• #41 Arteriovenous fistula – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/symptoms-causes/syc-20369567

  An arteriovenous (AV) fistula is an irregular connection between an artery and a vein. Blood flow avoids tiny blood vessels (capillaries) and moves directly from an artery into a vein. […] An arteriovenous fistula may be surgically created for use in dialysis in people with severe kidney disease. […] Treatment for arteriovenous fistulas includes monitoring, compression, catheter-based procedures and, sometimes, surgery. […] If you have signs and symptoms of an arteriovenous fistula, make an appointment to see your health care provider. Early detection of an arteriovenous fistula may make the condition easier to treat. It may also reduce the risk of developing complications, including blood clots or heart failure. […] Left untreated, an arteriovenous fistula can cause complications. Some complications may be serious. These include:

• #42 Arteriovenous Fistula Care for Patients Undergoing Hemodialysis

  https://www.asterhospitals.in/blogs-events-news/aster-rv-bangalore/arteriovenous-fistula-care-patients-hemodialysis

  Arteriovenous Fistula care in Patients on Hemodialysis […] Dos and Donts after AV fistula surgery: […] Keep the wound clean till it heals which might take 10 to 14 days. […] Start exercising the fistula hand by squeezing the sponge ball, 2 to 3 days after the surgery after the resolution of pain and swelling. […] Feel the thrill (vibration) by placing your fingers on the skin over the fistula at least two times a day. If it stops, seek medical help immediately. […] How much time it will take for the AV fistula to mature? […] It will take around six weeks for the fistula to mature. In some patients, we can use it early and in some, it might take long time to mature. A good fistula should have a diameter of 6mm and length of 6 cms. […] What are the complications of AV fistula? […] Infection can happen immediately after the surgery or later, but it is very rare. […] Thrombosis: Clots can happen in the AV fistula. Commonly happens if the blood pressure drops during or after the hemodialysis. […] Arterial steal phenomenon: Some patients can experience cold, numbness and pain in the fingers on the fistula hand. […] Aneurysms: Bulge in the hands over the course of AV fistula is seen when it is used for many years.

• #43

  https://childrenswi.org/publications/teaching-sheet/dialysis/1046-arteriovenous-fistula-or-graft

  An arteriovenous fistula is a large blood vessel that has a fast flow of blood. It is used to put needles into the body for hemodialysis. Minor surgery is done to connect a vein to an artery. A wrist or elbow is the best place for a fistula. It should last for many years. Most often, it takes 3 to 4 months for it to be ready (mature). Then it can be used for dialysis. […] Check every day for signs of infection: Redness, Swelling, Warmth, Drainage of pus, Fever or chills, Pain or tenderness. Be sure to feel for the thrill or buzz 2 or 3 times every day. If the fistula or graft starts to bleed, put firm pressure over it with a clean gauze pad until it stops. […] Extra care is needed to protect the fistula or graft. Be very careful not to: let blood pressures be done on that arm, let anyone other than dialysis staff do needle sticks in that arm, wear tight sleeves, jewelry or watches on that arm, carry heavy objects on that arm, sleep on that arm.

• #44 Arteriovenous Fistula Care for Patients Undergoing Hemodialysis

  https://www.asterhospitals.in/blogs-events-news/aster-rv-bangalore/arteriovenous-fistula-care-patients-hemodialysis

  Arteriovenous Fistula care in Patients on Hemodialysis […] Dos and Donts after AV fistula surgery: […] Keep the wound clean till it heals which might take 10 to 14 days. […] Start exercising the fistula hand by squeezing the sponge ball, 2 to 3 days after the surgery after the resolution of pain and swelling. […] Feel the thrill (vibration) by placing your fingers on the skin over the fistula at least two times a day. If it stops, seek medical help immediately. […] How much time it will take for the AV fistula to mature? […] It will take around six weeks for the fistula to mature. In some patients, we can use it early and in some, it might take long time to mature. A good fistula should have a diameter of 6mm and length of 6 cms. […] What are the complications of AV fistula? […] Infection can happen immediately after the surgery or later, but it is very rare. […] Thrombosis: Clots can happen in the AV fistula. Commonly happens if the blood pressure drops during or after the hemodialysis. […] Arterial steal phenomenon: Some patients can experience cold, numbness and pain in the fingers on the fistula hand. […] Aneurysms: Bulge in the hands over the course of AV fistula is seen when it is used for many years.

• #45 Self-care actions for the maintenance of the arteriovenous fistula: An integrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7424158/

  Venous punctures on the arm with AVF for blood collection or drug infusion are actions to avoid. […] Blood pressure checking and carrying excess weight on the arm with AVF were also cited as actions to be avoided by the patient. […] To maintain AVF functionality, avoiding excessive fluid intake between hemodialysis sessions was a caution mentioned in two studies. […] In class 2, which presented 29% of the text sequences, the objective of access care was to prevent or identify complications with the AVF. […] Among the complications that can be signaled from an AVF examination is thrombosis. […] One care action cited was the observation for bleeding in the AVF. […] As for hematoma care, it is recommended that cold compresses be applied in the first 24 h after the intercurrence, and warm compresses from that period onward.

• #46 Arteriovenous Fistula Care for Patients Undergoing Hemodialysis

  https://www.asterhospitals.in/blogs-events-news/aster-rv-bangalore/arteriovenous-fistula-care-patients-hemodialysis

  Arteriovenous Fistula care in Patients on Hemodialysis […] Dos and Donts after AV fistula surgery: […] Keep the wound clean till it heals which might take 10 to 14 days. […] Start exercising the fistula hand by squeezing the sponge ball, 2 to 3 days after the surgery after the resolution of pain and swelling. […] Feel the thrill (vibration) by placing your fingers on the skin over the fistula at least two times a day. If it stops, seek medical help immediately. […] How much time it will take for the AV fistula to mature? […] It will take around six weeks for the fistula to mature. In some patients, we can use it early and in some, it might take long time to mature. A good fistula should have a diameter of 6mm and length of 6 cms. […] What are the complications of AV fistula? […] Infection can happen immediately after the surgery or later, but it is very rare. […] Thrombosis: Clots can happen in the AV fistula. Commonly happens if the blood pressure drops during or after the hemodialysis. […] Arterial steal phenomenon: Some patients can experience cold, numbness and pain in the fingers on the fistula hand. […] Aneurysms: Bulge in the hands over the course of AV fistula is seen when it is used for many years.

• #47

  https://www.kidney.org.uk/fistula-care

  If steal syndrome is going to occur it usually develops soon after your fistula has been created. […] If either appears reduced or absent contact your renal unit or ward immediately. […] If your fistula begins bleeding profusely, as if your needles have just been removed, when you are not at the dialysis unit this is a MEDICAL EMERGENCY. […] Always tell nurses and dialysis doctor of any bleeds from your fistula of any size/description as acting on this may prevent a large fistula bleed occurring.

• #48 Arteriovenous Fistula Care for Patients Undergoing Hemodialysis

  https://www.asterhospitals.in/blogs-events-news/aster-rv-bangalore/arteriovenous-fistula-care-patients-hemodialysis

  Arteriovenous Fistula care in Patients on Hemodialysis […] Dos and Donts after AV fistula surgery: […] Keep the wound clean till it heals which might take 10 to 14 days. […] Start exercising the fistula hand by squeezing the sponge ball, 2 to 3 days after the surgery after the resolution of pain and swelling. […] Feel the thrill (vibration) by placing your fingers on the skin over the fistula at least two times a day. If it stops, seek medical help immediately. […] How much time it will take for the AV fistula to mature? […] It will take around six weeks for the fistula to mature. In some patients, we can use it early and in some, it might take long time to mature. A good fistula should have a diameter of 6mm and length of 6 cms. […] What are the complications of AV fistula? […] Infection can happen immediately after the surgery or later, but it is very rare. […] Thrombosis: Clots can happen in the AV fistula. Commonly happens if the blood pressure drops during or after the hemodialysis. […] Arterial steal phenomenon: Some patients can experience cold, numbness and pain in the fingers on the fistula hand. […] Aneurysms: Bulge in the hands over the course of AV fistula is seen when it is used for many years.

• #49

  https://journals.lww.com/nursingmanagement/fulltext/2010/10000/caring_for_a_patient_s_vascular_access_for.11.aspx

  Assess the vascular access for signs and symptoms of infection such as redness, warmth, tenderness, purulent drainage, open sores, or swelling. Patients with end-stage kidney disease are at increased risk of infection. […] After dialysis, assess the vascular access for any bleeding or hemorrhage. […] Assess for blebs (ballooning or bulging) of the vascular access that may indicate an aneurysm that can rupture and cause hemorrhage. […] Teach the patient: to make sure that dialysis needlestick locations are rotated to prevent stenosis and thrombus formation, to check the function of the vascular access several times a day by palpating it and feeling for vibration, to monitor for any bleeding after dialysis, to monitor for signs of infection, to keep the site clean, to avoid wearing any clothing or jewelry that restricts the access and to prevent anyone from using the extremity to obtain BP or perform venipuncture, not to use the arm with vascular access to carry heavy objects and not to sleep on the arm, not to use any creams and lotions on the vascular access site. […] Document assessment findings, any interventions and patient responses, patient teaching, and the patient’s level of understanding.

• #50 Arteriovenous Fistula Care for Patients Undergoing Hemodialysis

  https://www.asterhospitals.in/blogs-events-news/aster-rv-bangalore/arteriovenous-fistula-care-patients-hemodialysis

  Is the needling of the AV fistula painful? […] During initial stages, it might be painful. There are certain creams and ointment, which can be applied 30 60 mins prior to dialysis and can reduce pain to a considerable extent. […] What should I do if there is bleeding from the AV fistula site? […] There are chances of bleeding from the fistula site after dialysis as the patient would have received heparin. […] Suppose after removal, if the fistula site bleeds, not to panic, immediately give point compression at that site for 10 to 15 minutes, and if it is severe, visit your dialysis unit.

• #51 Arteriovenous fistula – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/symptoms-causes/syc-20369567

  Heart failure. This is the most serious complication of large arteriovenous fistulas. Blood flows more quickly through an arteriovenous fistula than it does through typical blood vessels. The increased blood flow makes the heart pump harder. Over time, the strain on the heart can lead to heart failure. […] Blood clots. An arteriovenous fistula in the legs can cause blood clots to form. Leg blood clots may lead to a condition called deep vein thrombosis (DVT). deep vein thrombosis (DVT) can be life-threatening if the clot travels to the lungs (pulmonary embolism). Depending on where the fistula is, it may lead to a stroke. […] Internal bleeding. Arteriovenous fistulas may cause bleeding in the stomach and intestines.

• #52

  https://journals.lww.com/cjasn/fulltext/2023/10000/optimizing_arteriovenous_fistula_care_in_kidney.20.aspx

  Arteriovenous fistula (AVF) is the preferred hemo-dialysis access because of its superior durability and lower infection and mortality rates compared with arteriovenous grafts and central venous catheters. […] However, recent evidence indicates that AVF may raise the risk of heart failure through insidious cardiac remodeling with a reported de novo occurrence of 10.2% and 18.3% at 1 and 3 years after kidney transplantation, respectively. […] This practice variation is important because cardiovascular disease is a significant driver of mortality beyond 1 year post-transplant, and even a minor increase in disease burden could have a disproportionate impact on the quality of life and life expectancy of this vulnerable population. […] Randomized controlled trials (RCTs) suggest that fistula ligation may reverse maladaptive cardiac remodeling in kidney transplant recipients.

• #53 Arteriovenous fistula – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/symptoms-causes/syc-20369567

  Heart failure. This is the most serious complication of large arteriovenous fistulas. Blood flows more quickly through an arteriovenous fistula than it does through typical blood vessels. The increased blood flow makes the heart pump harder. Over time, the strain on the heart can lead to heart failure. […] Blood clots. An arteriovenous fistula in the legs can cause blood clots to form. Leg blood clots may lead to a condition called deep vein thrombosis (DVT). deep vein thrombosis (DVT) can be life-threatening if the clot travels to the lungs (pulmonary embolism). Depending on where the fistula is, it may lead to a stroke. […] Internal bleeding. Arteriovenous fistulas may cause bleeding in the stomach and intestines.

• #54 Arteriovenous fistula – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/symptoms-causes/syc-20369567

  Heart failure. This is the most serious complication of large arteriovenous fistulas. Blood flows more quickly through an arteriovenous fistula than it does through typical blood vessels. The increased blood flow makes the heart pump harder. Over time, the strain on the heart can lead to heart failure. […] Blood clots. An arteriovenous fistula in the legs can cause blood clots to form. Leg blood clots may lead to a condition called deep vein thrombosis (DVT). deep vein thrombosis (DVT) can be life-threatening if the clot travels to the lungs (pulmonary embolism). Depending on where the fistula is, it may lead to a stroke. […] Internal bleeding. Arteriovenous fistulas may cause bleeding in the stomach and intestines.

• #55 Having an arteriovenous fistula formed – Looking after your arteriovenous fistula or graft | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/having-arteriovenous-fistula-formed/looking-after-your-arteriovenous-fistula-or

  Do not let any medical professionals take blood from your fistula or graft arm. Blood should always be taken from the veins on the backs of your hands. Please let staff know this if you are having blood taken. […] Remember that heavy bleeding from the fistula or graft is very rare. However, it is important that you and your family know what to do if it happens, as it is a medical emergency and could be life threatening. […] If the bleeding stops before an ambulance arrives, you should still go to the emergency department (AE) to get your fistula or graft checked. Please also let us know.

• #56

  https://www.kidney.org.uk/fistula-care

  If steal syndrome is going to occur it usually develops soon after your fistula has been created. […] If either appears reduced or absent contact your renal unit or ward immediately. […] If your fistula begins bleeding profusely, as if your needles have just been removed, when you are not at the dialysis unit this is a MEDICAL EMERGENCY. […] Always tell nurses and dialysis doctor of any bleeds from your fistula of any size/description as acting on this may prevent a large fistula bleed occurring.

• #57 Care of your arteriovenous fistula after surgery

  https://leaflets.ekhuft.nhs.uk/care-of-your-arteriovenous-fistula-after-surgery/html/

  Your dialysis nurse will check your fistula and will know when it is mature. […] If you have a tunnelled dialysis line for dialysis, once your fistula is being used for dialysis using two needles successfully for two weeks, your nurses will arrange for the line to be removed. […] A small number of fistula never work and you may return from theatre with a failed fistula. […] However the majority of fistula work immediately following surgery. […] Also, fistula tend to last years longer than any other kind of access. […] If this happens, call 999 immediately. […] Apply direct pressure to the area that is bleeding using gauze and several fingers. […] Elevate (raise) your arm above your head. […] If the bleeding does not stop after this time, please contact your Renal Unit or Marlowe Ward for advice.

• #58 Haemodialysis access with an arteriovenous fistula | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/treatments/vascular-access-for-dialysis/patient-info-haemodialysis-access-with-an-arteriovenous-fistula/

  Avoid pressure. Try to avoid lifting heavy objects which may put pressure on your fistula arm. Try not to sleep on that side of your body, too. […] Check it every day. Your kidney team will show you how to check for a vibration through your fistula (called a thrill or a buzz). If you don’t feel this, contact your kidney team straight away as the fistula may be blocked. […] Avoid having your blood pressure taken from your fistula arm as this could damage your fistula. […] Contact your kidney team straight away if your fistula feels hot, swollen or is causing you pain. […] Contact your kidney team immediately if you notice that your fistula’s normal vibration or thrill has stopped. […] If there is any bleeding from your fistula in between dialysis sessions, you need to get help immediately. Use a bottle top to cover the bleeding site and keep it firmly in place until you receive medical help.

• #59 Having an arteriovenous fistula formed – Looking after your arteriovenous fistula or graft | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/having-arteriovenous-fistula-formed/looking-after-your-arteriovenous-fistula-or

  Do not let any medical professionals take blood from your fistula or graft arm. Blood should always be taken from the veins on the backs of your hands. Please let staff know this if you are having blood taken. […] Remember that heavy bleeding from the fistula or graft is very rare. However, it is important that you and your family know what to do if it happens, as it is a medical emergency and could be life threatening. […] If the bleeding stops before an ambulance arrives, you should still go to the emergency department (AE) to get your fistula or graft checked. Please also let us know.

• #60 Haemodialysis access with an arteriovenous fistula | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/treatments/vascular-access-for-dialysis/patient-info-haemodialysis-access-with-an-arteriovenous-fistula/

  Avoid pressure. Try to avoid lifting heavy objects which may put pressure on your fistula arm. Try not to sleep on that side of your body, too. […] Check it every day. Your kidney team will show you how to check for a vibration through your fistula (called a thrill or a buzz). If you don’t feel this, contact your kidney team straight away as the fistula may be blocked. […] Avoid having your blood pressure taken from your fistula arm as this could damage your fistula. […] Contact your kidney team straight away if your fistula feels hot, swollen or is causing you pain. […] Contact your kidney team immediately if you notice that your fistula’s normal vibration or thrill has stopped. […] If there is any bleeding from your fistula in between dialysis sessions, you need to get help immediately. Use a bottle top to cover the bleeding site and keep it firmly in place until you receive medical help.

• #61 Arteriovenous Fistula (AV Fistula) | University of Utah Health

  https://healthcare.utah.edu/cardiovascular/treatments/arteriovenous-fistula

  The incision site should heal within one to two weeks. Be sure to watch for signs of infection, such as pain, redness, swelling, or fever. […] Before using the AV fistula, a vascular surgery provider will need to see you in the clinic to make sure that the AV fistula has matured. […] The care team teaches you how to protect your AV fistula. The following are some key things to remember to avoid any complications after your procedure: Keep the AV fistula area clean at all times. Be careful not to bump or injure the area. Watch for signs of infection. Don’t sleep with the access arm under your head or body. Don’t carry heavy objects on your fistula arm. Don’t wear tight sleeves or jewelry on the access arm. Don’t allow blood pressures to be taken on your fistula arm. […] If you notice any problems or have concerns, contact your vascular surgeons office right away.

• #62 Self-care actions for the maintenance of the arteriovenous fistula: An integrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7424158/

  To identify self-care actions for the maintenance of arteriovenous fistula of renal patients. […] The self-care actions identified in this study can guide a nursing care policy for implementation with protocols that help identify problems related to self-care actions and, thus, subsidize the development of actions aimed at the renal patient. […] An arteriovenous fistula is the best access for hemodialysis and, therefore, self-care actions to maintain its functionality should be followed by chronic renal patients. […] The self-care actions described in this review are important to the preservation of an arteriovenous fistula, which was made possible by the methodological quality of the studies that composed the sample. […] The important care that the patient on AVF maintenance needs to develop was identified in this study.

• #63 Self-care actions for the maintenance of the arteriovenous fistula: An integrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7424158/

  The self-care actions to maintain the FAV functionality identified in this study can guide a care policy to be implemented by nurses. […] The creation of protocols that help to identify problems related to self-care actions subsidize the development of educational actions aimed at the renal patient, favoring the maintenance of adequate practices with their access.

• #64 Nursing care the arteriovenous fistulas: literature review

  https://www.nucleodoconhecimento.com.br/health/nursing-care

  Hemodialysis for arteriovenous Fistula is a therapeutic modality of greater choice, because it is a vascular access that offers greater durability in the treatment and offering less risks of complications. […] The nurse plays an important role in the early identification of those complications and in the maintenance of arteriovenous fistula (AVF), through excellence in patient care with AVF. […] The study made it possible to meet the nursing care to arteriovenous fistula and concludes that the nurse Substititiva Renal Therapy service must be a specialist in Nephrology, endowed with technical and scientific knowledge in relation to the preparation and maintenance of arteriovenous fistula, ensuring durability the FAV and the extension of the life of the patient. […] The care adopted in the period ps-confeco surgical fistula are fundamental to the adequacy of hemodialysis access, and involve: the elevation of the Member in the early days, periodic exchange of dressings for the nurse and perform manual compression exercises with rubber ball to promote the maturation of venous access.

• #65 Learning needs of professional nurses to care for patients with arteriovenous fistula – Acta Paulista de Enfermagem

  https://acta-ape.org/en/article/learning-needs-of-professional-nurses-to-care-for-patients-with-arteriovenous-fistula/

  Learning needs of professional nurses to care for patients with arteriovenous fistula. […] To identify the learning needs of professional nurses to provide quality care for patients with arteriovenous fistula (AV Fistula) for hemodialysis. […] A great number of nurses (44.9 %) reported to have difficulties in providing quality care for patients with AV Fistula. […] Nurses had many learning needs to prepare them to care for patients with arteriovenous AV Fistula. […] This finding led to the development of a protocol to facilitated quality care nursing care.

• #66 Self-care actions for the maintenance of the arteriovenous fistula: An integrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7424158/

  The self-care actions to maintain the FAV functionality identified in this study can guide a care policy to be implemented by nurses. […] The creation of protocols that help to identify problems related to self-care actions subsidize the development of educational actions aimed at the renal patient, favoring the maintenance of adequate practices with their access.

• #67

  https://www.sciepub.com/AJNR/abstract/9986

  Patients with end stage renal diseases should be educated to enhance and maintain the arteriovenous fistula (AVF) in the better condition. […] application of self-care-behaviors nursing brochure for patients with arteriovenous fistula in hemodialysis patients.

• #68 AV Graft or Fistula for Permanent Dialysis Access

  https://navicenthealth.org/service-center/atrium-health-navicent-heart-vascular-care/av-graft-or-fistula-for-permanent-dialysis-access

  The AV fistula is preferred over grafts or catheters by most doctors for a number of reasons. It tends to offer the greatest amount of blood flow, so patients are in dialysis and uncomfortable for the shortest amount of time. Because they are a natural part of the body, they last much longer and are less expensive to maintain than a graft or catheter. They also offer a much lower risk of infection or clotting, which means fewer complications for patients who are already dealing with regular dialysis. […] To take care of an AV fistula, patients need primarily to ensure unrestricted blood flow to the fistula by avoiding tight clothing or jewelry. Pressure on the area from carrying heavy objects or blood pressure measurement can also impede blood flow.

• #69 Hemodialysis Access | Fistula, Graft, & Catheter National Kidney Foundation

  https://www.kidney.org/kidney-topics/hemodialysis-access

  A hemodialysis access, or vascular access, is a way to reach the blood for hemodialysis. […] Care includes hygiene and checking for problems. […] A fistula should be considered the first choice for your access because it generally lasts longer and has fewer problems such as infections and clotting. […] Whether your access is a fistula, graft or catheter, you should make sure to take good care of it. […] Your dialysis care team will teach you the steps of good access care. […] Check the blood flow several times each day by feeling for a vibration, also called a pulse or thrill. […] If an infection occurs, your doctor will order antibiotics for you. […] If your access develops a clot, you may need to go to the hospital for treatment.

• #70 How Long Can an Arteriovenous (AV) Fistula Last? – DaVita

  http://www.davita.com/treatment-services/dialysis/preparing-for-dialysis/how-long-can-an-arteriovenous-av-fistula-last

  An AV fistula is surgically created by connecting an artery and vein. […] The AV fistula is considered the gold standard access because: It is a connection of the patients own artery and vein so it is all natural. […] It has a lower infection rate than arteriovenous (AV) graft or central venous catheter. […] It lasts longer than arteriovenous (AV) graft or central venous catheter. […] Costs associated with creating and maintaining an AV fistula are less than arteriovenous (AV) graft or central venous catheter. […] Some patients may not be able to have an AV fistula because their arteries and veins are not strong enough. […] Each patient should talk with his or her doctor, and ask for vessel mapping to see if they are a candidate for a fistula. […] The longevity of the AV fistula, as witnessed by Anthony Logan, Barbara Raymond, John Horath and John Hart, makes it the best choice for patients who choose hemodialysis.

• #71 AV Fistula vs. AV Graft – Vein & Endovascular Medical Care

  https://www.astraveinvascular.com/av-fistula-vs-av-graft/

  AV fistula, used for long-term dialysis, connects a selected artery and a vein directly. […] AV graft connects the artery and vein indirectly, through a tube and graft. […] AV fistulas provide greater blood flow for more effective dialysis and reduced treatment times. […] An arteriovenous fistula (AV fistula) is a surgical access procedure to connect an artery and a vein directly. […] When AV fistula placement is done properly, you get a long-term vascular access for more effective management of end-stage renal disease.

• #72 Gel to improve development of an arteriovenous fistula holds promise for kidney-dialysis patient care – UAB News

  https://www.uab.edu/news/research-innovation/gel-to-improve-development-of-an-arteriovenous-fistula-holds-promise-for-kidney-dialysis-patient-care

  Gel to improve development of an arteriovenous fistula holds promise for kidney-dialysis patient care. Researchers at the University of Alabama at Birmingham and Endomimetics LLC are working to develop the first effective therapy to promote healthy AVF maturation. […] Therefore, the researchers concluded, direct application of the NO releasing nanomatrix gel to the AVF anastomosis immediately following AVF creation may enhance AVF development, thereby providing long-term and durable vascular access for hemodialysis. […] Joseph Garner, Ph.D., CEO of Endomimetics, says showing that the AVF Gel substantially increases the success rate of AVF development could result in dramatic improvement to the quality of life of patients, as well as a significant decrease in the cost of creating AVFs.

• #73 Gel to improve development of an arteriovenous fistula holds promise for kidney-dialysis patient care – UAB News

  https://www.uab.edu/news/research-innovation/gel-to-improve-development-of-an-arteriovenous-fistula-holds-promise-for-kidney-dialysis-patient-care

  Gel to improve development of an arteriovenous fistula holds promise for kidney-dialysis patient care. Researchers at the University of Alabama at Birmingham and Endomimetics LLC are working to develop the first effective therapy to promote healthy AVF maturation. […] Therefore, the researchers concluded, direct application of the NO releasing nanomatrix gel to the AVF anastomosis immediately following AVF creation may enhance AVF development, thereby providing long-term and durable vascular access for hemodialysis. […] Joseph Garner, Ph.D., CEO of Endomimetics, says showing that the AVF Gel substantially increases the success rate of AVF development could result in dramatic improvement to the quality of life of patients, as well as a significant decrease in the cost of creating AVFs.

• #74 Vascular and Interventional Radiology – Dialysis Access | UW Medicine

  https://www.uwmedicine.org/specialties/radiology/interventional-radiology/dialysis-access

  Traditionally, surgeons create arteriovenous fistulas (connections between an artery and a vein) during open surgery. Interventional radiologists offer an innovative method of fistula creation. Using an endovascular approach, they use heat and pressure from inside the blood vessels to connect an artery to a vein in the arm or leg. These fistulas mature over weeks to months and are then ready for dialysis use.

• #75

  https://journals.lww.com/cjasn/fulltext/2023/10000/optimizing_arteriovenous_fistula_care_in_kidney.20.aspx

  Taken together, patent fistulas constitute an additional burden for the cardiovascular system of kidney transplant recipients. […] Hence, providers need to be cognizant of the potential deleterious cardiac impact of AVF and be vigilant for early signs of evolving cardiac failure and pulmonary hypertension. […] We recommend a systematic evaluation of kidney transplant recipients with echocardiograms and sequential fistula flow measurements starting at 612 months after transplantation to decide who may benefit from prophylactic fistula ligation. […] In summary, although large-scale outcome studies are needed to confirm the benefit of prophylactic ligation after kidney transplantation, current evidence suggests that careful, individualized evaluation and intervention could confer cardiovascular protection.

• #76 Vascular Access Management and Care: Arteriovenous Fistula (AVF) | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-031-30320-3_9

  The arteriovenous fistula (AVF) represents the gold standard, among the vascular accesses, which allow hemodialysis treatment. The management of AVF has a fundamental importance, on its duration, and on the effectiveness of the hemodialysis therapy, affecting the quality of life of hemodialysis patients. […] Strategies on the use, surveillance, and prevention of complications have particular value, through a multidisciplinary approach, and in particular through the crucial nursing role.

• #77 Dialysis Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559085/

  Dialysis fistula creation is a commonly performed procedure for patients who suffer from the end-stage renal disease who require permanent vascular access for hemodialysis. Arteriovenous fistulas are the preferred initial access compared to prosthetic grafts or hemodialysis catheters. […] This activity outlines the preparation and complications of dialysis fistula creation and highlights the role of the interprofessional team in evaluating and managing dialysis fistulas. […] Dialysis nurses also play a critical role in evaluating and managing dialysis fistulas. Dialysis nurses can report arteriovenous fistula malfunction during dialysis, such as decreased flow rates (possible inflow or outflow obstruction), delayed hemostasis at needle puncture sites (possible outflow obstruction), or erythema and drainage overlying the fistula site (possible infection). […] Understanding complications such as ischemic steal syndrome and patients complaining of numbness or tingling after dialysis can prompt nurses to call surgical services sooner.

• #78 Nursing care the arteriovenous fistulas: literature review

  https://www.nucleodoconhecimento.com.br/health/nursing-care

  Hemodialysis for arteriovenous Fistula is a therapeutic modality of greater choice, because it is a vascular access that offers greater durability in the treatment and offering less risks of complications. […] The nurse plays an important role in the early identification of those complications and in the maintenance of arteriovenous fistula (AVF), through excellence in patient care with AVF. […] The study made it possible to meet the nursing care to arteriovenous fistula and concludes that the nurse Substititiva Renal Therapy service must be a specialist in Nephrology, endowed with technical and scientific knowledge in relation to the preparation and maintenance of arteriovenous fistula, ensuring durability the FAV and the extension of the life of the patient. […] The care adopted in the period ps-confeco surgical fistula are fundamental to the adequacy of hemodialysis access, and involve: the elevation of the Member in the early days, periodic exchange of dressings for the nurse and perform manual compression exercises with rubber ball to promote the maturation of venous access.

• #79 Self-care actions for the maintenance of the arteriovenous fistula: An integrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7424158/

  To identify self-care actions for the maintenance of arteriovenous fistula of renal patients. […] The self-care actions identified in this study can guide a nursing care policy for implementation with protocols that help identify problems related to self-care actions and, thus, subsidize the development of actions aimed at the renal patient. […] An arteriovenous fistula is the best access for hemodialysis and, therefore, self-care actions to maintain its functionality should be followed by chronic renal patients. […] The self-care actions described in this review are important to the preservation of an arteriovenous fistula, which was made possible by the methodological quality of the studies that composed the sample. […] The important care that the patient on AVF maintenance needs to develop was identified in this study.

• #80 Arteriovenous fistula creation for hemodialysis and its complications – UpToDate

  https://www.uptodate.com/contents/arteriovenous-fistula-creation-for-hemodialysis-and-its-complications

  Arteriovenous fistula creation for hemodialysis and its complications […] Two types of permanent vascular access are available for hemodialysis: the arteriovenous (AV) fistula and the AV graft. Of these, an AV fistula is preferred for long-term hemodialysis vascular access provided it is consistent with the patient’s end-stage kidney disease (ESKD) Life-Plan and overall goals of care and patient circumstances are favorable for its creation. A mature, usable AV fistula is generally preferred to an AV graft for incident AV hemodialysis access due to fewer long-term vascular access events (eg, thrombosis, loss of primary patency, interventions) associated with unassisted AV fistula use. AV fistula creation requires adequate arterial and venous anatomy to support its creation and a sufficient time interval to allow the AV fistula to mature prior to its use. Niestety, niepowodzenie dojrzewania pozostaje problemem, co podkreśla znaczenie oceny przedoperacyjnej.

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