About your fistula for dialysis Information for patients Sheffield Kidney Institute (Renal Unit)
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 veins suitable for dialysis you will need an operation to make a fistula in your arm. In this leaflet, we explain what a fistula 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 fistula? A fistula is the joining of an artery to a vein. Blood flow in the artery is stronger than the flow in the vein. When the artery is joined to the vein more blood flows from the artery into the vein. The vein stretches and becomes stronger. Fistulas (and dialysis catheters and grafts) are sometimes called vascular access. Why do I need a fistula? When you dialyse, blood is taken out of your body cleaned by a machine and returned to you rapidly. This is usually done three times a week. This will help you to lead a normal and healthy life. Needles will be placed into your blood vessel to take out and return the blood to your body. Your normal veins would not be strong enough to have needles put into them three times a week for dialysis treatment. They therefore need to be strengthened and this is done by diverting blood from arteries. page 2 of 12
The fistula is made to stretch the vein and make it stronger. Once the veins become strong enough you can then have needles put in to the vein and have dialysis treatment. Without the fistula (or a dialysis catheter or graft) you will not be able to have treatment on the dialysis machine. A fistula is the best way to have treatment on the dialysis machine because: there is less of a risk of getting an infection in a fistula than in a dialysis catheter or graft. your blood can usually be cleaned by the machine at a faster speed than with a dialysis catheter. This means your dialysis treatment may be more effective. From dialysis machine To dialysis machine page 3 of 12
How is a fistula made? A fistula is made by joining your own vein and artery together. This requires an operation. Fistulas are usually made at the wrist, but can also be made at the forearm or elbow. Before the operation, you will be seen by a surgeon who will decide if your veins can be used for a fistula and discuss with you what type of anaesthetic will be best for you. If you are suitable to have a local anaesthetic the surgeon will carry out the operation after numbing a part of your arm. You will be awake during the operation but will not feel any pain. You may need some other type of anaesthetic. If that is the case with you, an anaesthetist will need to give it to you. The anaesthetist will see you before the operation and talk with you about the type of anaesthesia that will be best for you. 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. page 4 of 12
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. 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 fistula is made? 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 and arm after the operation. The swelling should go down with time as the fistula develops. It is a good idea to take off rings and other jewellery from your arm before the fistula is made. 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. page 5 of 12
You will be able to feel the fistula "buzzing". This is a good sign as it means the fistula is working well. After the fistula has been made it takes between 6-12 weeks for the vein to become strong enough to start to be used for treatment on the dialysis machine. To help your vein become strong enough for dialysis you should exercise your arm by squeezing a ball for example. You should do this for about 5 minutes, 3 times a day for 6 weeks after the operation. If you have any problems or questions after your operation about your fistula you can call the renal unit for advice. The telephone numbers are at the end of this leaflet. Can anything go wrong after the fistula is made? As with any operation there is a risk of infection, bleeding and bruising. Sometimes there can be more swelling than usual. You may be advised to raise your arm on pillows when sitting or lying down. 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 page 6 of 12
Can anything go wrong later on? Sometimes the fistula does not become strong enough to be used for dialysis treatment. If this is the case, you may need to have another operation on the fistula or another fistula made. Some people have problems with their fistula clotting. This can mean that the fistula does not work well or stops working altogether. The common causes of a clotted fistula are: narrow or thin veins low blood pressure blood clotting problems (you may be given tablets to thin the blood to help stop this from happening). Occasionally, the vein in the fistula 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. Occasionally the fistula can become very big: we call this an aneurysm. An aneurysm can be caused by a narrowing in the fistula but usually nothing needs to be done unless it is causing problems. If you are having any problems, you may need more treatment to stop the aneurysm getting larger. If you have any concerns or the fistula is getting bigger, discuss this with the staff at the renal unit. 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 fistula has been made. 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 by the operation to make a fistula. This may cause you some pain and affect how you can use your hand. If this happens, you will need an page 7 of 12
operation to stop the fistula working to ease the pain and allow your hand to recover its use. It may take several months for this recovery to happen. How do I look after my fistula at home? Check your fistula every day to make sure that you can feel the buzz as this means that it is working properly. Do not wear tight cuffs, clothing, watches or bandages around your fistula arm. Try to avoid sleeping with your head resting on your fistula arm. Always keep your fistula as clean as possible as this will help prevent an infection. Wash your fistula arm with soap and water before dialysis and dry thoroughly. Do not let anyone (including doctors and nurses) take your blood pressure using your fistula arm. Always try to keep your fistula arm warm. Try not to bump or scratch the fistula. Keep it safe from sharp objects and your finger nails as they can cause your fistula to become infected. Never allow anyone to take blood from your fistula. Carry on using your hand as normal page 8 of 12
What should I do if something is wrong with my fistula? If your fistula 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 fistula working again the longer it has stopped. If you notice any swelling or redness in your fistula arm 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 fistula operation wound or over the fistula) 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 do I do if my fistula starts to bleed at home? If your fistula starts to bleed, apply pressure to the bleeding area and contact the unit straight away. If the blood starts spurting from a fistula 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 fistula. page 9 of 12
Contact details: If you have questions or need help and advice please call: Sorby Renal Outpatients (Renal Assessment Unit) 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 5136 0114 226 9481 01226 434 910 01246 512 626 01709 838 333 0114 229 0970 page 10 of 12
If your dialysis unit is closed, you can ring: (Northern General Hospital) Renal F Floor 0114 226 6391 or 0114 226 6393 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 PD4601-PIL1529 v7 Issue Date: September 2017. Review Date: September 2019