About your graft for dialysis Information for patients Sheffield Kidney Institute (Renal Unit)
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You will have discussed with your doctor that your kidney condition means that you need to have regular dialysis. In order for this to happen, we will need to take blood out of your body, clean it in a machine and return it back to you. The blood for dialysis will be removed and returned through suitable blood vessels called veins. To make the veins suitable for dialysis you will need an operation. In some cases the veins are not suitable and we have to use a synthetic (man-made) tube called a graft. In this leaflet, we explain what a graft is, what it does and how you need to look after it. We hope that we will have answered all your questions. If after reading this leaflet you would like to know more or have some questions then please speak to a member of staff at the renal unit. What is a graft? A graft is a synthetic (man-made) tube placed under the skin that joins your artery and vein. The graft will be placed under the skin in your arm or thigh where there are larger blood vessels. This graft acts as an artificial vein that can be used for taking out and returning blood to you. Why do I need a graft? When you dialyse, blood is taken out of your body, cleaned by a machine and returned to you quickly. This is usually done three times a week. Dialysis will help you to lead a normal and healthy life. Needles will be placed in your blood vessel to take out and return the blood to your body. Your normal veins are not strong enough to have needles placed into them three times a week for dialysis treatment. They therefore need to be strengthened by diverting blood from arteries. If your veins are not large enough or if they are not close enough to an artery to be joined together we need to use a graft. The graft acts as an page 3 of 12
artificial vein and can be used for dialysis. Needles can be placed in it whenever you need dialysis. Brachial artery Loop-shape graft Without the graft (or a dialysis catheter), you will not be able to have treatment on the dialysis machine. A graft is a better way to have treatment on the dialysis machine than a dialysis catheter because: there is less risk of getting an infection in a graft than in a dialysis catheter your blood can usually be cleaned by the machine at a faster speed meaning your dialysis treatment may be more effective Where is the graft placed? Grafts are placed under the skin either in the forearm, upper arm or thigh. They look like prominent veins which stand out all the time. Before the operation you will be seen by a surgeon who will decide the best site for the graft. Sometimes you may need a scan to identify suitable blood vessels for the graft. page 4 of 12
To have this operation you will need an anaesthetic. An anaesthetist will see you before the operation and talk with you about the type of anaesthetic that will be best for you. This could be by either numbing your whole arm or leg called a regional anaesthetic or by putting you to sleep - a general anaesthetic. When will I have the operation? When you have been seen in the outpatient clinic you may be given a date to have the operation if you need dialysis soon. If you do not need dialysis for some time, your name will be placed on a list. Nearer the time you need dialysis you will be contacted and given a date for the operation. We must obtain your consent for any procedure or treatment beforehand. Staff will explain all the risks, benefits and alternatives before they ask for your consent. If you are unsure about any part of the procedure or treatment that is being suggested, please do not hesitate to ask for more information. Do I need a check up before the operation? Before your operation, you will get an appointment to come to the pre-assessment clinic at the hospital. At the clinic, you will have tests to make sure you are well enough to have the operation. These tests may include measuring your blood pressure, an ECG (heart trace) and blood tests for example. The appointment may take up to three hours. It is very important that you come for this check up. The operation may need to be arranged for another time if you need more tests or are not fit enough to have the operation. page 5 of 12
How long does the operation take and how long do I need to stay in hospital? It usually takes about an hour to have the operation but it may take more or less time than this. Usually you do not need to stay in hospital for more than one day and sometimes you may be able to go back home on the same day. What happens after the graft is put in? Slight soreness after the operation is common. Taking painkillers like Paracetamol can help take any pain or soreness away. There is a small chance of some swelling of the fingers, arms or leg after the operation depending upon where the graft is placed. The swelling should go down with time. It is a good idea to take off rings and other jewellery from your arm before the operation. After the operation you will be given advice on how to care for the wound, when the dressing can be taken off and when the stitches can be removed. You will be able to feel the "buzzing" over the graft. This is a good sign as it means the graft is working well. The graft is usually ready to be used in about 2 weeks but in some cases the graft may be used earlier than this. If you have any problems or questions after your operation about your graft you can call the renal unit for advice. The telephone numbers are at the end of this leaflet. page 6 of 12
Can anything go wrong after the graft is put in? As with any operation there is a risk of infection, bleeding and bruising. Sometimes there can be swelling of your arm or leg more than usual. You may be advised to raise your arm on pillows when sitting or lying down or to keep your leg raised up. You may have some numbness around the scar and the thumb. This is caused by the nerves near the artery and vein being handled during the operation. The numbness should get better with time but occasionally it carries on. This will not stop you being able to use your hand. Can anything go wrong later on? Sometimes the graft can stop working. This is usually caused by a clot inside the graft. If this is the case, you may need to have an operation to unblock (declot) the graft. This may be done either by a radiologist (X-ray doctor) in the X-ray department or by a surgeon in the operating theatre. Unblocking (declotting) done in the X-ray department by a radiologist (X-ray doctor): This is done using a needle, wire and a type of balloon. It is usually done using local anaesthetic. It is not a painful procedure though some people may experience some discomfort. The graft may be able to be used straight away. Unblocking of your graft may also be done by the surgeon in the operating theatre using local anaesthetic. This would involve a small cut to the graft and the clot being removed. page 7 of 12
Occasionally the graft may need unblocking and a further piece of graft being put in (a bypass). This would be done by the surgeon in the operating theatre. A regional or general anaesthetic may be needed. It may not be possible to use the graft straight away. It may take some time for the swelling caused by the surgery to go down before the graft can be used. Some people have problems with their blood clotting. This can mean that the graft does not work well or stops working altogether. You may be given tablets to thin the blood to help stop this from happening. Occasionally the vein to which the graft is joined can become narrow over time (sometimes called a stenosis) and this can mean that your dialysis treatment is less effective. Again, you may need more treatment for this problem. Rarely, you may notice pain and coldness in the fingers especially during dialysis. This happens because there is less blood going to the hand and fingers after the graft has been put in. This is called "steal syndrome" and more treatment or another operation may be needed to stop this from happening. Very rarely, the blood supply to the nerves in the arm can be affected which can cause pain and may affect the function in the hand. This will need an operation to stop the graft working so that the pain and function of the hand can recover over many months. Sometimes the graft can become weaker over time and this could increase the chances of it bleeding. You will be sent an appointment for a scan of your graft after it has been in place for 2 years and then every year after that. This is to check for any signs of weakness. If a weakness is detected you may need to have a new graft put in. page 8 of 12
How do I look after my graft at home? Check your graft every day to make sure that you can feel the buzz as this means that it is working properly. Always try to keep your graft arm warm. Always keep your graft arm / leg as clean as possible as this will help prevent an infection. Wash your graft arm / leg with soap and water before dialysis and dry thoroughly. Do not remove the scabs on the graft. Do not wear tight cuffs, clothing, watches or bandages around your graft arm. Try to avoid sleeping with your head resting on your graft arm. Do not let anyone (including doctors and nurses) take your blood pressure using your graft arm. Never allow anyone to take blood from your graft. Try not to bump or scratch the graft. Keep it safe from sharp objects and your finger nails as they can cause your graft to become infected. Carry on using your hand as normal. page 9 of 12
What should I do if something is wrong with my graft? If your graft stops working (you can no longer feel a buzz) please call the renal unit straight away. The telephone numbers are at the end of this leaflet. It will be more difficult to get the graft working again the longer it has stopped. If you notice any swelling or redness in your graft contact the unit straight away. This may mean you have developed an infection. If you develop pain in your hand or arm (and it is not coming from the graft operation wounds or over the graft) contact the renal unit straight away. You may need to be seen by a doctor or a surgeon to see if you have steal syndrome and whether you need an operation to resolve the pain. What should I do if my graft starts to bleed at home? If your graft starts to bleed, apply pressure to the bleeding area and contact the unit straight away. If blood starts spurting from your graft at any time, apply firm pressure over the bleeding area and call 999 for an ambulance straight away. Tell ambulance control that you are a renal haemodialysis patient and that you are bleeding from your dialysis graft. page 10 of 12
Contact details: If you have questions or need help and advice please call: Sorby Renal Outpatients (Room 1) Monday - Friday 8.30am - 4.00pm Renal F Floor (Northern General Hospital) After 4.00pm and at weekends 0114 271 5320 0114 226 6391 or 0114 226 6393 Or, if you are already having dialysis you can ring the ward where you have your treatment: Peter Moorhead Dialysis Unit Sunday - Friday 7.00am - 9.00pm Renal G Floor Monday - Saturday 7.00am - 9.00pm Barnsley Dialysis Unit Monday - Saturday 7.00am - 9.00pm Chesterfield Dialysis Unit Monday - Saturday 7.00am - 9.00pm Rotherham Dialysis Unit Monday, Wednesday and Friday 7.00am - 10.00pm Tuesday, Thursday and Saturday 7.00am - 5.15pm Sheffield Dialysis Centre Sunday - Friday 7.00am - 6.00pm 0114 271 5158 0114 271 5136 or 0114 226 9481 01226 434 910 01246 512 626 01709 838 333 0114 229 0970 page 11 of 12
Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2017 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD5158-PIL1694 v5 Issue Date: September 2017. Review Date: September 2019