An arteriovenous fistula (AVF) is a join between an artery and a vein, usually in the arm, made during a small operation. The join makes the vein grow bigger and stronger so that dialysis needles can be put in at every session. That is why a fistula is often called a haemodialysis patient's "lifeline".
A well-cared-for fistula can last for years. This guide covers everyday care and the warning signs that need action straight away. Most of this advice also applies to an AV graft. Always follow the instructions of your own surgeon and dialysis team.
After fistula surgery
- Rest your arm on a pillow, above the level of your heart, for the first few days to reduce swelling.
- Keep the wound and dressing clean and dry until it heals, or as your doctor advises.
- Don't lift anything heavy with that arm for as long as you have been told.
- A fistula usually needs a few weeks to a few months to "mature" before it can be used. Your team will check it and tell you when it is ready.
Tip: If possible, have your fistula made early, before you actually need dialysis. This gives it time to mature and reduces the need for a temporary catheter.
Check your fistula every day
A working fistula has a strong flow of blood. You can feel it and hear it.
Feel the thrill
Rest your fingertips lightly on the fistula, near the surgical scar. You should feel a continuous buzz or vibration, like water rushing through a pipe.
Listen for the bruit
Hold your arm close to your ear. You should hear a continuous whooshing sound.
Check at least twice a day, for example when you wake up and before you go to bed. Get to know how your fistula normally feels and sounds, so you notice quickly if anything changes.
Hygiene and dialysis days
- Wash your fistula arm with soap and water every day, and again before each dialysis session.
- Don't scratch or pick the scabs over needle sites. Let them heal on their own.
- Don't put creams or lotions on the needle sites before dialysis, unless it is a numbing cream your team has given you.
- After a session, press on the needle sites as you have been taught until the bleeding stops. Don't press so hard that the buzz disappears.
- Nurses usually change where the needles go each session so that no single spot gets worn out.
Protect your fistula arm
- Never allow blood pressure readings, blood tests, drips or injections on your fistula arm. Use the other arm.
- Tell every doctor, nurse and lab technician that you have a fistula, including at other clinics and hospitals.
- Avoid tight watches, bangles or tight sleeves on that arm.
- Don't sleep lying on your fistula arm.
- Don't carry heavy bags, shopping or a handbag hanging from that arm.
- Protect the arm from cuts, knocks and burns when cooking or gardening.
Exercise for your fistula
Once the wound has healed, and if your team agrees, simple hand exercises can help a fistula grow and mature. For example, squeeze a soft rubber ball several times a day. Everyday activity such as walking is good for your general health too. Avoid lifting heavy weights with your fistula arm unless your team says it is fine.
Warning signs that need urgent action
No buzz, or a weak buzz
If you can no longer feel the thrill or hear the bruit, or it is much weaker than usual, contact your dialysis centre or hospital immediately. Don't wait for your next session. A fistula blocked by a clot can sometimes be treated if it is caught early.
Bleeding that won't stop
If blood is spurting or soaking through quickly, call 999 straight away, or ask someone to call for you, while you keep pressing on the spot.
- Press firmly with two fingers on gauze or a clean cloth, exactly over the spot that is bleeding.
- Keep pressing for at least 10 minutes without lifting your fingers to check.
- Lie down and raise your arm above the level of your heart.
- Do not tie anything around the arm.
If the bleeding has not stopped after 10 minutes of firm pressure, call 999 and keep pressing. Even if the bleeding stops, let your dialysis centre know.
Signs of infection
Redness, warmth, swelling, pain or pus at the fistula or needle sites, especially with a fever or chills. Contact your team the same day.
Other signs to report straight away
- Swelling of the whole arm, hand or face.
- Fingers that feel cold, numb, pale or bluish, or a painful hand, especially during dialysis.
- A fistula bulge that grows quickly, skin over it that looks thin or shiny, or a sore or scab that won't heal. These can raise the risk of bleeding.
Next steps
- Get ready for your first dialysis session.
- Find out about help with the cost of access surgery in the guide to dialysis costs and financial aid.
- Find a dialysis centre near you, and keep your centre's phone number somewhere easy to reach.