Using your arteriovenous fistula or graft

Once you have had your arteriovenous fistula (AVF) of arteriovenous graft (AVG) fitted, it usually takes around 6 weeks for the vein to get big enough for haemodialysis. 

If you need haemodialysis during this time, you will usually have a haemodialysis line inserted into a neck vein. 

Using your fistula or graft for dialysis

At the end of dialysis, the needles will be removed and a plaster will be placed over the needle site. This plaster can be removed later in the day, or the day after.

Sometimes the fistula or graft may bleed a little. If this happens, you should apply pressure, and the bleeding should stop.

If the bleeding does not stop and lasts longer than 10 minutes, you should follow our advice on heavy bleeding. 

What to do if you have a problem

You may get some complications once you are having dialysis and having your fistula or graft needled. 

If you have any of the following changes, you should tell your dialysis nurses quickly so that they can check your fistula or graft.

Bruising or swelling

This can happen due to the needle piercing the wall of the fistula or graft, causing swelling or bruising. Once your fistula or graft is ready (mature), this is less likely to happen. 

Infection

If you have any redness, pain, swelling or heat around your fistula or graft, tell the dialysis nurses immediately, as this could be a sign of infection.

Aneurysm

This is a swollen area which can develop over time. This can be due to the needles being put in the same area. 

If you are self-needling, you or your nurses should change your needling sites, if possible, to help avoid this. Buttonhole needling can also help.

Buttonhole needling is a different needling technique, which involves the needles being inserted into the same track for each dialysis session. The track takes about 2 weeks to form. The dialysis nurses would help you with this. Buttonhole needling can only be used by patients with AVFs, not AVGs. 

If your skin becomes thin or shiny, or you can see a pulse under the skin in the area where there is an aneurysm, tell the dialysis nurses immediately. 

Allergies

Tell the dialysis nurses if your fistula or grafts becomes red, or itchy after:

• applying anaesthetic cream
• cleaning the area
• putting on a dressing

You might have an allergy to the cream or dressing. Speak to your nurses for other options for the cream or dressing. 

Reduced blood supply to the hand (steal syndrome)

This can cause pain, coldness or tingling in your fingers or hand on your fistula or graft arm. Tell the dialysis nurses if you have any of these symptoms.

Blocked fistula or graft

This causes the ‘thrill’ in the fistula or graft to stop, or become weaker. It can be caused by a narrowing or a blood clot. A blocked fistula or graft may need surgery or another procedure to unblock it. It is important to tell the dialysis nurses immediately if you think your fistula or graft is blocked. 

Scab

If a scab over your needle site does not heal quickly, or gets larger, tell the dialysis nurses. A scab which has not healed can put you at risk of bleeding and may need a review with the vascular access team. 

Bleeding during dialysis

If blood oozes around your needle sites during dialysis, tell the dialysis nurses immediately. 

Bleeding after dialysis

Once you have had the needle removed, if you have bleeding which lasts more than 10 minutes, please tell the dialysis nurses.

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.

Being aware of the possible complications above, and reporting them quickly should make sure that you do not have heavy bleeding.