Arteriovenous Fistula Creation For Hemodialysis What you should know An arteriovenous (ahr-te-re-o-VE-nus) fistula (FIS-tu-lah), also called

AVF, is a surgical connection of an artery directly to a vein. This is usually done in those needing hemodialysis. Hemodialysis is a treatment for acute (sudden) and chronic (long term) kidney failure. It uses a machine that works like the real kidneys to clean waste from your blood. The AVF will act as the bridge for blood to go into the hemodialysis machine. The fistula is usually done on the arm that is not always used (left arm if you are right handed and vice versa). It is where your caregiver puts needles during hemodialysis. Blood will go out from and come back to the AVF after being cleaned by the hemodialysis machine. When someone suffers acute or chronic kidney failure, dialysis is a mechanical way to take over the job of cleansing the blood and balancing body fluids. Sometimes kidney function can be restored and dialysis can provide temporary support until this occurs. There are two types of dialysis currently available, peritoneal dialysis where the blood is filtered through a membrane in the abdomen and hemodialysis where the blood circulates through a machine outside the body and is filtered as it circulates. Hemodialysis treatment takes between three and five hours and is usually done three times a week. An entry point or access to the vascular system is needed. There are three types of vascular access: grafts, catheters and arteriovenous fistula. The AV fistula is best for a person whose veins are large enough as it is less likely to become infected or form clots, statistically lasts a long time and it improves the possibility of choosing self-dialysis. An experienced AVF creation surgeon at our facility can advise you on your options.

Healthy kidneys clean the blood by removing harmful substances like excess fluid, minerals, and toxic (harmful) wastes. They also make substances that help keep your bones strong and your blood healthy. Kidney failure causes harmful wastes to build up in your body, leading to a rise in your blood pressure. It may also cause your body to retain excess fluid and not make enough red blood cells. When this happens, you may need treatment to replace the work of your failing kidney. Having an AVF for hemodialysis may relieve your symptoms of kidney failure, and improve quality of life.

Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks
to make an arteriovenous fistula carries certain risks. You may bleed more than expected or get an infection. You could have trouble breathing or get blood clots. You could have an allergic reaction to an anesthesia medicine. Your caregivers will watch you closely for these problems. You may have continued pain or swelling after the surgery. Sometimes the surgery may not be successful and need to be done again. If you do not have surgery, the pain or symptoms you have may get worse. Call or ask your caregiver if you are worried or have more questions about your surgery. The week before your surgery:

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Ask a family member or friend to drive you home after your surgery. Do not drive yourself home. Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery. If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery. Tell your caregiver if you have had previous catheters, procedures, or surgery done on your arms. Your caregiver may also ask you more about your previous diseases or medicines that you are taking. If you are a female, tell your caregiver if you know or think that you are pregnant. You may need to have blood tests, electrocardiogram (ECG), chest x-ray, and other tests to know how your kidneys are. Ask your caregiver for more information about these tests that you may need. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

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The night before your surgery:

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Remove any nail polish. You may be given medicine to help you sleep. Ask caregivers about directions for eating and drinking.

The day of your surgery:

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Write down the correct date, time, and location of your surgery. What to bring: You may want to bring items such as a toothbrush and bathrobe. Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital. If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn. Do not wear tight-fitting clothes on the day of your procedure or surgery. Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine. An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past. You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

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Treatment What will happen:

You will be asked to change into a hospital gown. You will be given medicine to help you relax or make you drowsy. You will be taken on a stretcher to the operating room. You may be given a local, regional or general anesthesia to control pain during the surgery. You will be placed lying on your back. The whole arm where the AVF will be done will be cleaned with a cleansing liquid. Sheets will be put over you to keep the area clean. During your surgery, an incision (cut) will be made on the skin, midway between the blood vessels. Special tools will be used to separate the vein and the artery from nearby tissues. Once the blood vessels are seen, your caregiver will decide on how to join them together. Incisions will be made on both vessels and they will be attached with stitches (threads). After the vessels are joined together, the other ends of the artery and vein are tied and cut. This is done to direct the blood to enter into a single passageway. Once the fistula is created, the skin will be closed with stitches.

After surgery: You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. If you had general anesthetic, an adult will need to drive you home. Your driver or someone else should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room. Waiting area: This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area. Contact a caregiver if

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You cannot make it to your appointment on time. You have a fever. You have a skin infection or an infected wound near the area where the surgery will be done. You have questions or concerns about your surgery.