What is the best way to check for patency of the arteriovenous fistula for hemodialysis?

What is an arteriovenous (AV) fistula?

An arteriovenous (AV) fistula is a type of access used for hemodialysis. It can be used whether dialysis is performed at a dialysis center or you perform home hemodialysis (HHD). An AV fistula is a connection between an artery and a vein creating a ready source with a rapid flow of blood. The fistula is located under the skin and is used during dialysis to access the bloodstream.

Fistulas are the preferred type of access because it utilizes the patient’s own vessels and does not require permanent placement of foreign materials such as those needed to create an AV graft or catheter. The AV fistula, formed by the patient's own vessels, is less infection-prone than a catheter, is less likely than a graft to have problems with clotting and provides good blood flow that can last for decades.

While a fistula is easier to work with than other access types, that doesn’t mean it’s completely care-free. So here are some tips to take care of a fistula to maintain optimal blood flow for dialysis treatments. 

Exercising for your fistula after surgery

An AV fistula must mature for several weeks or months before it can be used for hemodialysis, so after it is surgically created, your doctor will ask you to work on strengthening it. The more access arm exercises you do to help strengthen it, the sooner you’ll be able to use your fistula. Your doctor may recommend certain arm and finger exercises that will strengthen the fistula. The exercises your doctor recommends will depend on where your fistula is located. Fistulas are usually located in the forearm or upper arm. Before you start any exercise, it’s important to consult your doctor.

Keeping your fistula clean

Once your AV fistula is strong enough to be used for hemodialysis, it is crucial that you keep it clean. Although a fistula is less prone to infection than other dialysis types, proper hygiene is still important:

• Look for redness or swelling around the fistula area.
• If you experience any pain in the fistula area, tell your doctor immediately.
• If you get a fever, this can be a sign of infection.
• Wash and pat dry your fistula arm thoroughly right before each treatment. Your dialysis facility will provide you with supplies.

Proper blood flow through the fistula

Blood needs to flow smoothly through your AV fistula. To reduce the risk of blood clots, be careful not to put extra pressure on the area. This may require some changes in your daily habits: 

• Do not wear tight-fitting shirts.
• Do not wear jewelry (such as bracelets) that may restrict blood flow on your access arm.
• When carrying things (groceries, bags, luggage), make sure the straps or handles don’t tighten around your fistula.
• When having your blood pressure taken or blood drawn, use your non-fistula arm.
• When sitting or sleeping, make certain that your head, pillow or cushion doesn’t rest on your fistula.

Checking your fistula blood flow

Check the blood flow through your AV fistula daily. This is done by touch and sound. When you place your fingers over your fistula, you should be able to feel the motion of the blood flowing through it. This sensation is the “thrill.” Let your doctor know if the thrill ever feels different. To listen for your blood flow, use a stethoscope and place the bell flat on your fistula. The sound you hear is called the “bruit” (pronounced broo-ee). Any change in the pitch may indicate a clot (thrombolysis) or a narrowing (stenosis) of the fistula. This sound may change from a whooshing noise to a whistle-like sound.

Summary

More than half of all dialysis patients are now using AV fistulas because it’s healthier, easier to maintain and produce better results than other access methods. Taking care of your fistula through strengthening exercises, cleanliness and checking daily for proper blood flow can make your dialysis treatments more manageable and effective.

4. Headache, deteriorating level of consciousness and twitching.

Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

D. Documenting precise intake and output

For the client with ascites receiving diuretic therapy, careful intake and output measurement is essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented, could place the client at risk for serious fluid and electrolyte imbalances. Hypokalemia, not hyperkalemia, commonly occurs with diuretic therapy. Because urine output increases, a client should be assessed for hypovolemia, not hypervolemia. Weights are also an accurate indicator of fluid balance. However, for this client, weights should be obtained daily, not weekly

A patient with stage 4 chronic kidney disease asks what type of diet they should follow. You explain the patient should follow a:

A. Low protein, low sodium, low potassium, low phosphate diet
B. High protein, low sodium, low potassium, high phosphate diet
C. Low protein, high sodium, high potassium, high phosphate diet
D. Low protein, low sodium, low potassium, high phosphate diet

A, B, E

Procedural information includes what will or should be done for surgical preparation, including what to bring and what to wear to the surgery center, length and type of food and fluid restrictions, physical preparation required, pain control, need for coughing and deep breathing (if appropriate), and procedures done before and during surgery (such as vital signs, IV lines, and how anesthesia is administered). The other options are sensory and process information (see Table 18-6).

How do you check for fistula?

How do you check the maturity of AV fistula?