There are a few things you will need to do once you have had your AV fistula created to maintain it 'in good shape' and minimise the possibility of infection, blood clotting or any other complication.
The following regular fistula maintenance is strongly recommended:
- Use soap and warm water to clean the access point daily and immediately before having dialysis treatment. Avoid scratching the area around the access point and not remove any scabs.
- Look out for any possible signs of infection such as a warm sensation or any redness near the access point. Do this every day.
- Check the access point daily to ensure that there is blood flow. There is a vibrating sensation at the access which is normal and should be present (it is sometimes referred to as 'the thrill') and indicates that blood is flowing correctly. If you do not feel this you should contact Dr Hagley.
- Be careful not to injure or put unnecessary pressure on the access point. This means not wearing tight clothing or any jewellery on or near that arm, not carrying heavy items using that arm and not sleeping on the arm. Neither should any blood be taken from that arm, nor blood pressure be monitored on that arm.
- Change the site where the needle is inserted into the access each time (called 'rotation') and apply only mild pressure when taking the needle out.
- Bleeding - if there is any bleeding when removing a needle apply mild pressure to the access. If there is excess bleeding or if bleeding does not stop within half an hour, call Dr Hagley.
When having dialysis treatment
During a dialysis session, the nurse will continually monitor blood flow rates and will conduct various tests to ensure that the blood has been fully treated (i.e. metabolites have been removed from the blood). If there are any concerns you will likely have an ultrasound of the fistula organised and be referred back to Dr Hagley.
In order to keep the fistula working at optimal levels you may require further surgery. Dr Hagley prefers to perform this via keyhole (minimally invasive) surgery with the use of balloons and stents.