A well-functioning vascular access is key in the treatment process. It allows performing a procedure such as haemodialysis.

It is very important to properly care for the vascular access so that it can fulfil its task and function as long as possible without complications.

Depending on the patient's condition, it is possible to create three different types of vascular accesses: vascular fistula, vascular prosthesis and central catheter.

A fistula is the best and safest type of vascular access. What should you keep in mind and how should you care for the fistula so that it functions as long as possible without complications?

An arteriovenous fistula is created during minor surgery to connect an artery and a vein. Before it can be used, several weeks described in the various stages of its "maturation" must pass.

Stage I

Leaving the hospital with a newly created fistula

Within the first few days of a fresh fistula you may still experience swelling and discomfort from the stitches in the skin.

To reduce these discomforts:

  1. Rest your arm and elbow on a small pillow
  2. Protect the anastomosis site (suture site) against injuries or against contact with domestic animals (protection against injuries and infection)
  3. Do not lift objects heavier than 3 kg with the hand where the fistula is located

Also:

Protect the dressing from getting wet.

Stage II

The period of fistula "maturation"

During the period of "fistula maturation" awaiting the time it can be used, experienced medical staff at the clinic may recommend exercises to strengthen and thicken the walls of the fistula vessels, which will facilitate their puncture.

The first puncture will be performed approximately 6 weeks after the formation of the fistula from own vessels, or earlier if a vascular prosthesis is used.

Starting the use of a fistula is preceded by a thorough assessment by the medical staff of the dialysis clinic to check whether the width of the vessels and the blood flow through the fistula fully qualify it for puncture.

  1. Clean the area around the fistula with lukewarm water and soap.
  2. Gently drying the skin, check that the murmur in the fistula can be felt.

Exercises are selected individually, the most recommended ones include:

  1. Resistance exercises:
    a) With an outstretched, slightly raised arm, holding a flexible object in your hand (for example: a foam ball, etc.), perform rhythmic gripping movements (maintaining the pressure for about 3-5 seconds) and releasing, repeating these sequences at least 10 times.
    b) With two fingers of the hand with the fistula hold a clothes peg and perform a rhythmic clenching and opening movement for 5 minutes.

  2. Strengthening exercises, repeated 5-10 times
    a) Clenching fists.
    b) Bending and extending the wrist.
    c) Bending and extending the arm at the elbow joint

Stage III

Fistula puncture period

It is very important to properly care for your fistula or vascular prosthesis, and by following these rules you can reduce the risk of complications.

Remember to:

  1. Protect the vascular access against any pressure or injury:
    a) Avoid tight-fitting clothes, jewellery and any other items that may constrict the vascular access.
    b) Avoid sleeping on the arm with vascular access.
    c) Avoid putting stress on the vascular limb: Do not lift heavy objects.
    d) Do not allow blood to be drawn or blood pressure measured on the arm with the fistula.
    e) The dressing placed on the fistula after dialysis can be removed only the next day.
  2. Practice proper skin care:
    a) Wash the area around the vascular fistula daily with lukewarm water and soap and always before starting dialysis.
    b) Do not scratch the fistula area and never remove the scabs.
    c) The dressing used after dialysis should be removed the next day and changed if it is dirty or soaked.

  3. Protect the skin around the fistula:
    a) Do not use creams, lotions or soaps that irritate the skin.
    b) Avoid contact with irritating and stinging plants, e.g. nettle, Sosnowsky's hogweed.
    c) Protect the skin around the fistula area from sunburn.

  4. Monitor fistula functioning:
    a) Check the fistula daily for signs of infection (pain, redness, warmth and the presence of purulent discharge).
    b) Check daily that there is no bleeding from the fistula puncture area.
    c) Monitor its functioning: check if you can feel the vascular murmur with your fingertips when you touch it. If the vascular murmur is inaudible or muted, inform the dialysis clinic immediately.

Anetta Cekała

Nursing Director Diaverum Poland

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