• Reference Number: HEY1256/2021
• Departments: Day Surgery (DSU)
• Last Updated: 21 October 2021

Introduction

This advice sheet has been produced to give you information following an Arteriovenous fistula procedure. It is not meant to replace discussion between you and the healthcare team. If after reading it, you require further explanation please discuss this with a member of the healthcare team.

Your Consultant is………………………………………………….

Your Surgeon is…………………………………………………….

If you have any problems or need further advice please contact

Hull Royal Infirmary:

Renal Access Nurse (01482) 675039

Ward 50         (01482) 675050 (Nurses station) (01482) 674980 (Sisters Office)

Renal Unit     (01482) 608748 (Nurses Station)

Special Instructions:

Looking after your fistula after your discharge

You will have dissolvable stitches at the site of the operation.

Keep your fistula arm warm as this will help the blood flow through the fistula.

You may be given dressings to cover your fistula to protect it until it is healed.

The Dialysis nurse will look after your fistula when you attend for dialysis.  If you are not currently on dialysis an appointment will be made for you to attend the Vascular Access clinic in 6 – 8 weeks’ time.  Any concerns in the interim please contact the Renal Access Nurse.

It is very important to check that your fistula is working. The nurse will show you how to do this before you go home.

Pain

You may experience some mild pain following your operation.  Paracetamol should give adequate pain relief if required. Please follow the instructions provided with the medication.

Please DO:

• Check that your fistula is ‘buzzing’ every day
• Exercise the hand on your fistula arm regularly, for example using a stress ball

Please DO NOT:

• Apply any creams or lotions on your wound
• Allow the wound to become soaking wet when bathing /showering

Apply any tight clothing or jewellery on your fistula arm (such as watches, cuffs, tight clothing, armbands etc)

• Lift heavy objects with your fistula arm for at least eight weeks
• Let anyone take your blood pressure on your fistula arm
• Let anyone take blood from or insert any type of needle except for dialysis needles in your fistula arm
• We advise that you do not drive for at least 48 hours after your procedure. You should only drive again when you are free of pain and able to perform an emergency manoeuvre comfortably. You should check with your insurance company to make sure you are covered to start driving again. If you are taking pain relief medication, please check with a pharmacist whether it is safe for you to drive.

Complications

Bleeding

Significant bleeding from a newly formed fistula is uncommon. Significant bleeding is more common once the fistula is being needled. Bleeding should be controlled by direct pressure to the point of bleeding and elevation where possible.

Infection

Wound infection is uncommon. You will notice redness, pain, heat and some swelling around the wound. There may be a discharge of fluid. Infection can usually be successfully treated with antibiotics.

Change in sensation

The nerves run close to the vessels and so can get damaged by the procedure. This may cause numbness, tingling and paraesthesia (pins and needles). This reduced sensation may be very noticeable at first but normally diminishes with time.

Swelling of the fistula

Fistulae tend to swell over time and can become very large in the long term.  However, if you notice a significant amount of swelling in the days following your surgery then this can indicate some bleeding under the skin or infection.

Pain or cramping in the fingers or hand

Sometimes a fistula may borrow a little too much of the blood destined for the hand and this can cause pain or cramping.  Further surgery may be required to increase the flow of blood to the hand.

Emergencies

Please seek help immediately (call an ambulance or go to the Emergency department) if the following occurs:

• You have significant bleeding which doesn’t stop with simple pressure or elevation
• You notice features of infection and begin to feel unwell or have a fever

Should you require further advice on the issues contained in this advice sheet, please do not hesitate to contact the Renal Access Nurses on  (01482) 675039