Preparation / Aftercare
How to prepare for creation of a vascular access
In preparation for creation of a vascular access, the patient should reserve one arm which should not be used for blood taking, intravenous lines (IVs) or taking of blood pressure. A duplex ultrasound, which is non-invasive, may be done to assess the size and quality of the veins.
What to expect during and after the operation
Most vascular access procedures can be performed on an outpatient basis, under local or regional anaesthesia. The anaesthetist may administer some sedative medication to allow the patient to be relaxed and drowsy, but general anesthesia is usually not required.
After the operation, patients should keep the incision covered and dry for at least two days. The incision should not be soaked or scrubbed until it is completely healed. The arm that the access was created in should be elevated on a few pillows while sitting and sleeping to keep swelling at a minimum. A mild amount of swelling and pain at the incision site is to be expected. If these symptoms become severe, your doctor should be contacted as soon as possible.
Patients may experience some coolness, numbness or tingling in the fingertips of the arm that the access was created in. This is normal and improves or resolves with time. If these symptoms become severe, a situation termed "steal", contact your physician as soon as possible. This results from the access "stealing" blood away from the hand and there are procedures that can be performed to address this condition.
Tips to keep the access healthy
The arm with the access should not be slept on or used to carry heavy items. The arm should also not be used for blood draws or blood pressure measurements and injections should not be given into the access. Clothing or accessories worn on the arm should be loose and non-constricting. The area over the access should be kept clean.
A functioning access will have a vibration that is called a "thrill." Your doctor or dialysis staff can show you how to feel for the thrill. If the patient notices that the thrill has disappeared, he/she should contact the medical team as soon as possible.
Potential Complications
Complications that can occur include infection and bleeding. The surgeon should be contacted as soon as possible for any fever, drainage from the incision or active bleeding. Steal, as described above, is an uncommon complication.
A potential complication of arteriovenous fistulas is non-maturation. In other words, the vein never enlarges or becomes thick-walled enough to be used for dialysis. In some cases, causes for non-maturation can be identified and corrected, allowing maturation to occur.
After a fistula or graft has been in place for a period of time, it may become abnormally large, or develop an aneurysm. There are procedures that can be performed to correct aneurysmal fistulas.
Arteriovenous fistulas and grafts can develop narrow areas (stenoses) which may decrease the efficiency of dialysis or put the access at risk for developing a clot. Stenoses can be treated with an operation, or with a minimally invasive angioplasty procedure. If a blood clot develops and prevents the flow of blood, it may be salvaged with an unblocking procedure if detected early.
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Dr. Peter Robless
