Fistula - caring for your fistula once you have started dialysis
What is a fistula?
A fistula is an enlarged vein (usually in the arm), created by joining an artery and vein together.
Connecting the artery to the vein creates much greater blood flow into the vein. As a result, the vein enlarges and strengthens, making inserting needles for haemodialysis treatments easier.
Why should I care for my fistula?
Fistulas are the best way to access your blood for haemodialysis. It is important to take care of your fistula to help prevent complications.
- Do not wear tight fitting clothing or wear a watch on your fistula arm.
- Do not carry plastic shopping bags or loads of firewood over your fistula arm.
- Use your non-fistula arm for blood samples, blood pressures or insertion of drips.
- Use gentle pressure to stop bleeding when the needle is removed.
- Always hold your needle sites with two or more fingers.
Ask your dialysis nurse to teach you how to “feel” the vibrating feeling called a ‘thrill” or hear the “whoosh whoosh” sound with a stethoscope.
Check your fistula once a day, every day.
- Wash your fistula arm well in the shower and pat dry.
- Moisturise your skin on your non dialysis days and use a non-alkaline soap such as Dove or Goat soap, to keep your skin in good condition.
- Leave the band-aid dots on for at least eight hours after dialysis, but not longer than 18 hours.
- Do not scratch off the scab over the needle site, as this may cause a major bleed.
If you think your fistula is infected, you should see either the renal nursing staff or a doctor in the Emergency Department of the hospital on that day.
Signs of infection include:
- pain/swelling at your needle sites; or
- feeling unwell or you have shivers and shakes.
Infection can occur at the needle site or in the bloodstream.
If bleeding occurs at home, apply pressure with a clean cloth.
Bleeding usually settles. However, if bleeding is excessive, spurts, or continues beyond 15 minutes, call an ambulance.
If the bleeding settles quickly, continue applying pressure for an additional five minutes before applying a dot band-aid.
At your next dialysis session tell your renal nurse that the bleeding occurred, so we can work out the cause of this bleeding.
What if a black area appears on my fistula?
This is not common. However, if it does occur come to the hospital as soon as possible.
It is important to find out if there is any infection present or any risk of bleeding.
If you are unable to feel or hear your fistula, it is very important that you see staff so that they can do a thorough check.
Go to the Emergency Department at the Royal Hobart Hospital.
Advising staff straight away may mean that the blood flow in the fistula can be restored.
Rotating needle sites and inserting needles in as much of the vein as possible will help to keep the vein wall strong, so your fistula should last longer.
You can help your renal nurse by pointing to where the needles were placed at your last dialysis session.