Main Content. Important Phone Numbers. Top of the page. Dialysis Exercise for your new AV fistula What is a fistula? What is a fistula used for? Two needles are put into the fistula in your arm each time you have a hemodialysis treatment. Where is the fistula and what does it look and feel like? Why do you need to exercise your arm that has the fistula? Exercise gets blood flowing to your arm. Before surgery Start the exercises as soon as you find out you need a fistula.
After surgery Start doing the exercises 2 weeks after surgery when the areas on the skin that were cut incision sites have healed. Or, an HD catheter can be placed in a large vein in the groin. The biggest plus of an HD catheter is that it can be put in and used the same day. But, since catheters are a doorway into your body, the risk of infection—and death—is far higher. Catheters are best used for only a short time when possible.
Learn more about catheters here. There are only about ten sites on the body where an AV fistula or graft can be made :. You will visit the surgeon to plan for your access first. Bring someone with you if you can, as a second pair of ears.
Medicare pays for this, and other health plans may, too. How many dialysis accesses did you do in training? Studies show that surgeons who did at least 25 do a much better job than those who did fewer. What kind of pain medicine will you prescribe for me, and how should I take it?
You may get your access as an outpatient and go home the same day. The surgery tends to take an hour or so. You may have general anesthesia, and be asleep. Some fistulas or grafts need just a small incision cut or two. Others have much longer incisions. You may have stitches—or staples—to close your skin back up.
At home, your arm will be swollen, and you will need pain pills for a few days. Keep your arm higher than your heart as much of the day as you can, to help the swelling go down.
Resting your arm on a pillow or the back of a couch can help. Never squeeze an access arm with elastic, a watch, or by carrying something across it. Call your care team right away if there is a change—or you have chills or a fever. Not all access surgery works on the first try. You may need an ultrasound to find problems. A too narrow vein or poor blood flow can be fixed. Sooner is better than later to save an access. As the vein gets blood from the artery, the vessel walls thicken.
Light exercise, like squeezing a rubber ball or a hand grip a few times a day, can help. As a fistula matures, it will vibrate. The buzz you feel thrill is a sign of a healthy access. A fistula with no thrill is in trouble. Call the emergency number you were given if your clinic is closed. Study finds that a new device boosts fistula success! A graft does not have to mature and can be used as soon as it heals weeks.
A warm glove can ease a minor ache during HD. If the problem is worse than this, talk to your surgeon. Rarely, people have lost a finger, hand, or arm to an access problem that was not taken care of right away. During HD, two large needles are placed in the access. One needle takes blood to the dialyzer filter. The other needle brings blood back to the body. Since HD is done at least three times a week, how the needles are placed matters! There are three ways to place them—two good, and one bad.
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Health Information Library. Vascular Access Failure. Topic Overview Dialysis is a lifesaving treatment when you have kidney failure. Call your doctor right away about any signs of trouble. Make a habit of talking with your dialysis nurses and doctor about how well your access is doing. What are the options for hemodialysis access? Permanent access There are two permanent access types: An arteriovenous AV graft is made by inserting a small tube between an artery and a vein, usually in the upper arm or forearm.
A graft is a good choice if you have small veins or other problems. It can sometimes be used as soon as 1 week after placement. But a graft may not last as long as a fistula. It's more likely to get infected or to get narrow and cause blood clots. An arteriovenous AV fistula is made by directly connecting an artery to a vein, usually in the upper arm or forearm.
A fistula tends to last longer than a graft, and it's less likely to cause blood clots and get infected. You have to plan ahead for a fistula, because it needs at least several months to heal after placement. But a fistula is the most dependable access type. Short-term dialysis access If you need to start dialysis right away, your doctor may place a tube in a vein, usually in your neck or chest. Even if you need immediate dialysis, your doctor may still suggest that you consider having an AV fistula created for long-term treatment.
To determine whether your veins are healthy enough and large enough for an AV fistula, you will need to have a procedure, known as vessel mapping, performed.
This can be done using an ultrasound machine or by injecting contrast dye into your veins while under fluoroscopy a type of x-ray so an image, or map of your veins, can be obtained and evaluated. After surgery, you may experience some pain, swelling and bruising near your access site for a few days.
This is normal. You may also notice a vibration coming from your access site. In fact, over the first week following your surgery, this thrill will strengthen. Before your AV fistula can be used, it needs time to mature.
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