What is an Arterio-venous fistula (AVF)?

An Arterio-venous fistula (AVF) is created when a surgeon connects an artery (a blood vessel transporting blood from the heart to the body) directly to a vein (a blood vessel taking blood from the body to the heart).

This is usually done at the wrist or elbow. This causes more blood to flow through the vein.

As a result, the vein grows larger and stronger and makes it possible to insert the needles (cannula) needed for dialysis treatment. The fistula can usually be used for dialysis 8-12 weeks after your operation.

What are the risks?

There are some risks to having a fistula:

• Infection - An infection may develop at the wound site, and you may need antibiotics.
• The fistula may block and stop working - If this happens you may need another operation.
• Swelling in the fistula arm after your operation -
• It is important to move your arm – gentle regular movements are recommended. Movement may help swelling to go down and will help to stop your arm from becoming stiff.
• Loss of feeling or pain in the hand and/ or fingers - This can happen if you have reduced blood flow to your hand. You should discuss this with your Renal Doctor, GP or dialysis nurse as soon as possible.

After your operation

The operation takes about one hour, and you will need to stay in hospital overnight afterwards. You will need to arrange for someone to take you home. If you do not have someone, please speak to the nursing staff.

You may notice a small amount of blood on the dressing and/or some bruising around the wound site. This is normal and should go away in a few days.

The stitches on your wound may be dissolvable or non-dissolvable, and we will let you know what type of stitches you have before you leave the hospital. If they are non-dissolvable stitches, ask your GP or your dialysis nurse to remove them 10- 14 days after your operation. If they are dissolvable, you don’t need to do anything.

You may feel pain in your arm. It may be swollen, and a little red. Nurses will give you some pain relief if you need it. The nurses will tell you what you can take for pain relief when you go home.

Your hand should be able to feel something touching it, be warm when you touch it, and your fingers should move normally. Your hand should not feel cold. If you notice a change in the way your hand feels or moves, please tell the nurses.

Before you leave hospital

Your dressing will be changed before you leave hospital. The new dressing needs to stay in place for 10-14 days. Your dressing can be removed by your GP, dialysis nurses or the Dialysis Access Nurse.

Before going home, you will be given a discharge summary & an ultrasound form. You will be contacted in 2-4 weeks after surgery for a Vascular Access review clinic follow-up appointment which will be 5-6 weeks after your operation. For patients living in Southern NSW, please arrange a follow up appointment with the Renal Outreach Nurse. Please have your ultrasound done before your follow-up Vascular Clinic appointment.

You will also be given instructions with exercises you can do with your arm. Do not start the exercises until 2 weeks after surgery or after you have seen the Dialysis Access Nurse or NSW Renal Outreach Nurse.

Caring for your fistula

You can take care of your fistula by following these steps:

• Be careful not to bump your arm on hard surfaces for the first few days after your operation.
• Rest your arm; the wound needs time to heal.
• Do not lift anything heavy with your fistula arm for the first 2 weeks.
• Do not let anyone take blood from your fistula arm.
• Do not let anyone check your blood pressure on the fistula arm.
• Do not wear any tight sleeves or a watch that may restrict the flow of blood through your fistula arm.
• Be careful not to lie on your fistula arm.

Checking your Fistula

Everyday check for a ‘thrill’ and ‘bruit’. These tell you that your fistula is working.

• ‘Thrill’ or ‘buzz’ - A thrill or buzz is like a vibration caused by blood flowing through the fistula and can be felt by placing your fingers just above your incision line.
• ‘Bruit’ (pronounced brew-ee) - Listen for a sound called a ‘bruit’ near the fistula incision site. A ‘bruit’ is a whooshing sound. You may need to use a stethoscope to hear the ‘bruit’. The Dialysis Access Nurse or your dialysis nurse can teach you how to listen for a ‘bruit’.
• Check your fistula arm for any changes in colour, temperature, tingling, numbness, pain or swelling. Notify the Dialysis Access Nurse or your dialysis nurse if any of these things occur.

When should you contact us?

If you experience any of the following symptoms:

• The fistula becomes red, swollen or painful. The appearance of the fistula changes, for example a lump appears
• You experience a tingling feeling in your hand and/or fingers
• You can no longer feel a ‘thrill’ or ‘buzz’ in the fistula or hear a ‘bruit’.

Contact details

Business Hours

(Monday to Friday 8am to 4:30pm) Canberra Hospital Dialysis Access Nurse

• Phone (02) 5124 4564
• Mobile 0466 485 751

Your local dialysis unit on ______________________

Your Renal Outreach Nurse ____________________

After hours

Go to the Emergency Department of your local hospital if you experience any of the described symptoms after hours,
You will be given an alert card; you need to show this when you go to the Emergency Department
The alert card tells clinicians that you are a renal patient and have a dialysis access. If you don’t have an alert card, please ask your nurse.