Overview
What Is An Arteriovenous Fistula ?
An AV fistula requires advance planning because a fistula takes a while after surgery to develop—in rare cases, as long as 24 months. But a properly formed fistula is less likely than other kinds of vascular access to form clots or become infected. Also, properly formed fistulas tend to last many years—longer than any other kind of vascular access. A surgeon creates an AV fistula by connecting an artery directly to a vein, frequently in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis treatments easier. For the surgery, you’ll be given a local anesthetic. In most cases, the procedure can be performed on an outpatient basis.
Risks
Most complications that occur during dialysis can be prevented or easily managed if you are monitored carefully during each dialysis session.
Possible complications may include:
- Low blood pressure (hypotension). This is the most common complication of hemodialysis. It is seen more often in women and in people older than 60.
- Muscle cramps. If cramps occur, they usually happen in the last half of a dialysis session.
- Irregular heartbeat (arrhythmia).
- Nausea, vomiting, headache, or confusion (dialysis disequilibrium).
- Infection, especially if a central venous access catheter is used for hemodialysis.
- Blood clot (thrombus) formation in the venous access catheter.
- Technical complications, such as trapped air (embolus) in the dialysis tube.
Long-term complications of dialysis may include:
- Inadequate filtering of waste products (hemodialysis inadequacy).
- Blood clot (thrombus) formation in the dialysis graft or fistula.
- Cardiovascular disease (heart disease, blood vessel disease, or stroke).
Why It Is Done ?
Hemodialysis is often started after symptoms or complications of kidney failure develop.
Symptoms or complications may include:
- Signs of uremic syndrome, such as nausea, vomiting, loss of appetite, and fatigue.
- High levels of potassium in the blood (hyperkalemia).
- Signs of the kidneys' inability to rid the body of daily excess fluid intake, such as swelling.
- High levels of acid in the blood (acidosis).
- Inflammation of the sac that surrounds the heart (pericarditis).
Hemodialysis is sometimes used when sudden (acute) kidney failure develops. Dialysis is always used with extra caution in people who have acute renal failure, because dialysis can sometimes cause low blood pressure, irregular heart rhythms (arrhythmias), and other problems that can make acute renal failure worse.
What can I expect during hemodialysis ?
Every hemodialysis session using an AV fistula or AV graft requires needle insertion. Most dialysis centers use two needles—one to carry blood to the dialyzer and one to return the cleansed blood to your body. Some specialized needles are designed with two openings for two-way flow of blood, but these needles are less efficient. For some people, using this needle may mean longer treatments.
Some people prefer to insert their own needles, which requires training to learn how to prevent infection and protect the vascular access. You can also learn a “ladder” strategy for needle placement in which you “climb” up the entire length of the fistula, session by session, so you won’t weaken an area with a grouping of needle sticks.
An alternative approach is the “buttonhole” strategy in which you use a limited number of sites but insert the needle precisely into the same hole made by the previous needle stick. Whether you insert your own needles or not, you should know about these techniques so you can understand and ask questions about your treatments.
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