Hemodialysis Access

Patients that are on, or plan to start, hemodialysis have better short- and long-term outcomes if they receive dialysis through a arteriovenous fistula. The word "fistula" means an abnormal or surgically created connection between two vessels. The creation of an arteriovenous fistula, in which an artery and vein are surgically connected to each other, takes place in an outpatient surgical setting. No foreign material is inserted into the patient. The connection of the artery and vein is below the skin, so nothing is extruding from the patient after surgery.

This operation does not require general anesthesia but rather is performed with the aid of a peripheral nerve block and sedation. The operation typically takes one hour, and patients go home from the recovery room after surgery.

Once the operation is complete, it takes an average of 6-8 weeks for the vein to grow or mature enough to be usable for hemodialysis.

For patients that do not have veins suitable for arteriovenous fistula creation, a graft can be placed between an artery and a large, deep vein in the arm. The graft is then accessed by the hemodialysis staff for dialysis. The operation to place an arteriovenous graft is also an outpatient procedure and does not require general anesthesia.

Patients should make sure they do not eat or drink anything after midnight the day before their surgery. For patients who take medications in the mornings, they may take them as directed with a small sip of water.

After Your Surgery: AV Fistula/AV Graft Discharge Instructions (PDF)

Common Questions Regarding Arteriovenous Fistulas

What is an arteriovenous fistula?

The word fistula means an abnormal connection. In this case, the connection is between an artery and a vein created by a surgeon. This will be used as the access point to receive dialysis.

What is an arteriovenous graft?

An arteriovenous graft is a connection between an artery and a vein using a piece of artificial tubing that is attached on one end to an artery and on the other end to a vein. The tube is placed entirely under the skin. The graft (tube) may be synthetic or may be a transplanted animal or human blood vessel.

Where are arteriovenous fistulas located?

Fistulas can be created in many locations. We most often place them in the wrist, forearm, and upper arm.

How long does it take a fistula to mature before it can be used for dialysis?

Arteriovenous fistulas can take between 6-12 weeks to mature and arteriovenous grafts can generally be used 2-3 weeks after surgery.

What do I need to do to prepare for my surgery?

• You should not have anything to eat or drink after midnight the night before your scheduled procedure. You may take medications as directed with a small sip of water only.
• Follow instructions given to you by your surgical team regarding the use of any blood thinning medications around the time of your surgery.
• Make sure someone accompanies you on the day of your surgery who can transport you home after you are discharged.

What can I do to help my fistula mature more quickly?

It's important to perform forearm exercises with the aid of a stress ball. You should squeeze and release the ball rapidly for 10 minutes 6 times per day.

Can I shower after arteriovenous fistula surgery?

It is okay to shower immediately after surgery with the plastic dressing in place. You may also shower after the dressing has been removed (follow discharge instructions for removal). Do not soak in bathtubs/hot tubs/pools/lakes until cleared by your provider.

When can I remove the outer dressing after surgery?

The outer dressing can be removed 48 hours after surgery. It is okay to cover the incision site again with a sterile gauze pad, or it can be left open to air.

What should I do after arteriovenous fistula surgery?

• You will be discharged from the hospital with a sling that should be worn until feeling/function returns to your arm.
• The recovery room nurse will give you a stethoscope after surgery. You should be able to hear the bruit and feel the thrill of the fistula. If at any time you cannot hear the bruit or feel the thrill of your fistula, please call our office.
• Watch for any signs of infection (redness and/or warmth around the incision site and/or pus draining from the incision). If you are noticing any of these signs, please call our office immediately.
  • In order to prevent any possible complications, the following are recommended:
  • Avoid tight-fitting shirts
  • Do not wear any jewelry, such as a watch or bracelet, that may restrict blood flow to your fistula
  • Do not carry or lift anything heavy that could put pressure on your fistula
  • Make sure to have healthcare providers take your blood pressure and draw blood in your non-fistula arm.

When sleeping, make sure that you do not rest your head or pillow on your fistula site.

Is it normal to have bleeding, swelling, or pain after surgery?

• Yes, minor bleeding after surgery is typical.
• Please call the office if your bandage is SOAKED with blood.
• It is normal to experience some pain and swelling the first few days after surgery. Keep your arm elevated above the level of your heart whenever possible to help control swelling and ease any discomfort.
  • Your hand and arm may numb for the first 24 hours after surgery due to the nerve block placed by the anesthesia team. The numbness will wear off gradually.
  • If you do not regain feeling in your arm/hand or if your hand becomes pale, blue, or turns cold to the touch, please call our office immediately.
• You may experience some mild bruising at the incision site, which is typical after surgery.
• You may experience some clear to pink fluid drainage at your incision site. If this happens, it is okay to cover the incision site with a sterile gauze pad.

Do I need to come back to the clinic after my surgery?

​Yes. You should be seen in the clinic 2-3 weeks after your surgery, where we will check your fistula and incision and remove any staples. Please call Kristin at 720-848-0833 to make your appointment.