Overview

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 arteriovenous fistula (AVF) is a type of vascular access. It’s a connection that is made by joining a vein onto an artery.

An AVF causes more blood to flow through the vein. Because of this, the vein grows larger and stronger. This makes it possible for dialysis nurses to repeatedly insert the needles needed for haemodialysis treatment.

Other types of vascular access include arteriovenous grafts (AVG) and central venous catheters (also known as dialysis lines).

Benefits of having an AVF

We need to get access to your bloodstream so that the dialysis machine can clean your blood. An AVF is usually the best form of vascular access for haemodialysis. An AVF is likely to last longer, and you are likely to have less complications (such as infections) than with other types of vascular access.

Once the fistula is formed it usually takes around 6 weeks for it to become big enough to be used for haemodialysis. 

Risks of having an AVF

You should be aware of problems that any problems happen, and report any changes or concerns to the nursing team looking after you, so that they can be dealt with quickly.

If you have any of these symptoms, you should contact the vascular access nurse: 

Bleeding

The fistula may bleed. Very occasionally a blood transfusion might be needed.

Infection

The wound can get infected, causing redness or heat. This might need treatment with antibiotics.

Blocked fistula

The fistula may block and stop working. You can check that your fistula is working each day, by placing your hand over the fistula and feeling the ‘thrill’ which is a buzzing sensation. This ‘thrill’ is caused by the high flow of blood through the vein, and is a sign that your fistula is working well. The nurse will show you how to feel for this sign.

Swelling in the fistula arm after surgery

It is important to move the arm as much as possible after surgery. This movement may help swelling to go down, and will prevent the arm from becoming stiff.

Reduced blood supply to the hand (steal syndrome)

Sometimes, too much blood might travel through the fistula vein and lead to reduced blood flow to your hand. This can cause pain, coldness or tingling in the fingers or hand, on your fistula arm.

Other treatment options

For most people, a fistula is the best option for haemodialysis access, but this is not suitable for everyone. Here are the other treatment options that might be available to you.

Arteriovenous graft (AVG)

An AVG is similar to a fistula, but instead of the artery being directly connected to a vein, a synthetic tube is used to join them together. The tube is placed under the skin. Grafts are usually ready to be used for dialysis more quickly than a fistula.

Central venous catheter (also known as a dialysis line) 

A piece of synthetic tubing is inserted into one of the large veins, usually in the neck. 

Your kidney care team and your surgeons will discuss these options with you in more detail at the access clinic.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what it involves and agree to have the treatment. 

If you would like more information about our consent process, please speak to a member of staff caring for you.

Preparing for an AVF  

If you are taking anticoagulant medicine (blood thinning medicine) to thin your blood, you should tell the doctor or nurse. These medicines include:

• warfarin
• dalteparin
• enoxaparin
• injections, such as heparin

We will tell you when to stop taking the medicine before the procedure, and when it is safe to start taking them again.

You should also tell the doctor or nurse if you are taking antiplatelet medicine (such as aspirin, clopidogrel or dipyridamole). They will tell you if you should continue taking the medicine or stop it temporarily before your procedure.

If you have any questions about your medicine and what to do before the procedure, please contact the ward or vascular access nurse.

General anaesthetic

If you are having a general anaesthetic, you must not eat or drink anything (fast) for 6 hours before your surgery. You can drink still water up to 2 hours before your operation. You will arrive on the morning of your operation and you will usually need to stay in hospital overnight.

Local anaesthetic

If you have your surgery under a local anaesthetic, you can eat and drink normally. You will arrive on the morning of your operation and should be able to go home on the same day. You will need to arrange for someone to take you home. If this is not possible please let us know before the day of your surgery.

The surgeon will discuss these options with you in the access clinic.

During an AVF formation

To form the fistula, you will need to have surgery. 

The surgeon will join an artery (a blood vessel transporting blood from the heart around the body), directly to a vein (a blood vessel taking blood back to the heart). This is usually done at the wrist or the arm.

Leaving hospital

When you leave hospital, you will need to check your fistula each day for a buzzing sensation known as a ‘thrill’. Before you leave the ward, the nurses looking after you will explain how to check your fistula.

You may notice a small amount of blood visible on the dressing or some bruising around the wound site. This is normal.

The stitches on your wound will be dissolvable or non-dissolvable.

If they are dissolvable, you do not need to do anything else other than following the advice about looking after your AVF. 

If they are non-dissolvable will need to have them removed. You can have them removed at your GP surgery 7 to 10 days after your operation. You will need to contact your GP to arrange this. If you prefer, you can contact the access team who can remove them instead.

You will also have a dressing on the wound. Your GP can look at this for you, or if you are coming to the hospital for another appointment, the kidney care team can check it for you. If you have any concerns before your appointment, you can contact the access team.

Keep the wound clean and dry until it is healed, to avoid infection. Your wound might be tender for a few days after your operation. Any pain can be relieved with regular painkillers that you can buy from a pharmacy or shop.

You should be able to return to normal activities within 1 to 2 weeks.

You should only drive again when you are free of pain and can do an emergency stop comfortably. You should check with your insurance company to make sure you are covered to start driving again. They might refuse to meet a claim if they feel you have driven too soon.

If you are taking painkillers please check with a pharmacist if it is safe for you to drive. If you are not sure about when to resume driving, please visit your GP to check your progress.

You can help your fistula to develop by squeezing a rubber ball in your hand. If you do not have a rubber ball, you can also try opening and closing your fist, or squeezing a pair of socks that have been rolled into a ball shape. You can do this exercise as often as you like.

Pain after an AVF formation

You can expect some discomfort after the anaesthetic wears off. We will give you pain relief for this.

It is important that you take these painkillers on a regular basis for the first few days. When taken regularly, the medicine is kept at a constant level in your body and will control your pain better.

After a few days, you can gradually reduce the medicine until you do not need it any more. 

Please contact the ward or your GP if you find the pain difficult to control.

We will explain any medicines given to you before you leave the hospital. If you are unsure of anything, please contact your ward or your GP for advice.

It is important that you do not take more than the recommended dose (amount) of any medicine you are given. Please make sure you read the label.

When your AVF will be ready for haemodialysis

It usually takes about 6 weeks for the vein to get big enough for the haemodialysis needles to be inserted. If you need haemodialysis during this time, you will usually have a central venous catheter (also known as a dialysis line) inserted into a neck vein. 

What to do if you have a problem at home

A nurse will check your new fistula when you return to clinic. However, you should contact us if:

• the fistula becomes red or swollen and/or painful
• the fistula looks different, for example, a lump appears over the wound
• you have a tingling sensation in your hand or fingers
• you can no longer feel a ‘thrill’ or buzzing sensation

Follow-up appointments

We will contact you to arrange a follow-up appointment to have your fistula reviewed within 4 to 6 weeks. If you do not hear from us in this time, please contact us.