Looking after your arteriovenous fistula or graft
Having an arteriovenous fistula formed
If you are having haemodialysis treatment, dialysis nurses will need to have access to your blood stream and veins. This is called vascular access.
There are different forms of vascular access, and they include an AVF and an AVG.
Arteriovenous fistula (AVF)
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.
Arteriovenous graft (AVG)
An AVG is also formed during an operation. A surgeon will put a piece of synthetic tubing under the skin to join the artery and vein. This makes it possible to repeatedly insert the needles, which are needed for haemodialysis treatment.
How to take care of your AVF or AVG
Do
- Try not to knock your arm for the first few days after your fistula or graft has been formed.
- Rest your arm. The wound needs time to heal.
- 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.
- Try not to lie on your fistula or graft arm.
Do not
- Do not lift anything heavy with your fistula or graft arm for a week after you’ve had the fistula or graft formed.
- 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.
- Do not let anyone check your blood pressure on the fistula or graft arm.
- Do not wear any tight sleeves or watches that may restrict the flow of blood through your fistula or graft arm.
- Do not loop heavy bags over your fistula or graft.
What to do if you have a problem
Heavy bleeding
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.
Call 999 if:
You have any heavy bleeding from the fistula or graft.
- Seek help immediately from anyone who is around. Heavy bleeding can make you feel faint, so alert someone as quickly as you can.
- Phone 999 for an ambulance and tell the operator that you have heavy bleeding from a dialysis fistula or graft.
- Apply a small clean dressing and firm pressure to the fistula or graft with your fingers. Do not use a large dressing, for example, a towel, which may prevent you applying enough pressure in the right place.
- Lie down and lift the arm. If the bleeding isn’t stopping, ask someone to help you by supporting your arm, in the air, over you. Make sure you are applying pressure in the right place.
- Stay calm. Bleeding can usually be stopped with enough pressure. It may take more pressure than usual.
If the bleeding stops before an ambulance arrives, you should still go to the emergency department (A&E) to get your fistula or graft checked. Please also let us know.
Resource number: 4137/VER3
Last review: September 2023
Next review: September 2026
