What is a fistula 

An arteriovenous fistula, or AFV, is a vessel that is made by meeting a vein to an artery in your arm while an operation to shapes an accessible blood vessel that gives enhanced flows of blood that are adequate for dialysis. 

The procedure of joining the vein to the artery enables for an increase in the size of the vein as well as flow in it, and this segment of the vein is called the ‘fistula’.

 A fistula is the decent vascular access for dialysis because it inclines to have fewer problems and last longer than other kinds of dialysis access.

HOW SHOULD I TAKE CARE OF MY FISTULA?

There are various things you should do to maintain your fistula. We frequently call your fistula your ’lifeline’ because it is so crucial in enabling good dialysis.

1. Keep your fistula sterile  – although infections are slightly likely with a fistula they can still occur. Once it is healed following surgery, rinse your arm with soap and water daily and  always wash it before dialysis.
2. Assess your fistula regularly – the nurse will guide  you on how to examine for a pulse or vibration through your fistula (called a thrill) or a sound (called a bruit). If you can’t feel it you must contact your unit or renal ward the very day.
3. Do not let anything hinder the blood flow in your arm– do not enable your blood pressure to be taken on your fistula arm and do not put constricting clothes or jewelry.
4. Do not hold up heavy shopping bags on your fistula arm. Neglect sleeping on your fistula arm.

5.Normally, you should resist allowing anyone to take blood from your fistula arm when you are not on dialysis. Nevertheless, if blood sampling is very tough from your other veins it is permissible for an experienced phlebotomist to take blood from a mature fistula which is in daily use for dialysis.

6. Never permit a cannula to be inserted into your fistula for the administration  action of drugs or IV fluids.

7. Try not to scratch your fistula or do anything else which can result in an injury to it. If you undergo itching, let your doctor be aware so that treatment can be considered to relieve the itching

Signs to pay attention for:-

Although a fistula is the decent sort of access and is least inclined to develop problems, you do need to be conscious of problems that can occur so they can be acted upon quickly:-

• Bruising and swelling – if blood leaks out of the vessels and into the enclosing tissue, it can result in bruising and localized area swelling. This is usually affected by a needle coming affected vessel into the tissue (called ‘bumping’) or by not squeezing firmly when you’re needle is removed. Bruising and swelling can as well occur if you move your arm around during dialysis, yet bruising and swelling are much less likely to happen as the fistula matures.

1. Redness or heat – although infection is less inclined to develop in a fistula this can still happen. Please reach out to your renal unit or renal ward instantly if you experience pain, redness, swelling at your fistula site; an increased temperature, or if your fistula feels hot or looks infected.

1. Aneurysm – this is a puffy area that develops as an outcome of the vessel becoming weakened, normally due to needles being frequently inserted in the same area. You may notice aneurysms on the fistula that have established a long duration. Aneurysms are less inclined to develop if your need sites are altered on each dialysis (rope ladder) or if buttonhole needling is used. If the skin comes to be thin and shiny in an aneurysmal area and you can recognize the fistula pulsing under the skin, please inform your dialysis staff.

1. Steal syndrome – this is the outcome of your fistula depriving the area below it of blood, it can result in your hand and fingers to  feel cold, painful or numb. Sometimes, this can lead to more severe symptoms such as ulceration and incapability to use the hand ddue to pain. If steal syndrome is going to happen it usually develops soon after your fistula has been developed. Sometimes, this may indicate itself once dialysis is initiated. Please make your dialysare nurses and doctors familiar if this occurs so it can be treated if necessary 

1. Bleeding from fistula– this can be a tragedy if it happens when you are not on dialysis – but such emergencies are very unusual.

Another bleeding  that you should be cautious for is blood oozing around your needles usually on dialysis or putting up with a much longer time for bleeding to stop post-dialysis. Bleeding after dialysis or oozing slightly from your fistula at other moments can imply that your vessel has restricted and is rising the pressure within the vessel. This may also result in a raised venous pressure reading on your dialysis machines. Occasionally, the bleeding may be related to any ‘’blood-thinning’’ treatment that you may be taking, such as warfarin. If you glance at any of these signs please let your nurses and doctor know so known to examine. Most issues of this nature can be fixed to ensure your fistula keeps healthy.

1. Allergies – If your fistula comes to be red, itchy, and sore after applying the anesthetic cream or any cleaning agent or chlorhexidine, let your nurses aware   so an  alternative the product can be utilized. Also, let the nurse know if you react to the tape or plasters utilized.

Declotting of a fistula

A fistula can clot because of a narrowing by hampering the blood flow rate through the fistula. The clot can be discarded and this is carried out by a radiologist who inserts a catheter along a small guidewire to the clot which provides medication into the clot to break it up or a mechanical device is utilized to break the clot down. Alternatively, if radiological strategies fail, the clot can sometimes be removed by surgery.

What must  not do with a fistula?

• Do not take blood pressure measures from your fistula arm

• Do not have any blood tests were obtained from your fistula arm 
• No needles, infusions, or drips run in your fistula arm 
• Do not put any tight or restrictive clothing on your fistula arm
• Neglect sleeping on your fistula arm