Fistula

A fistula is formed when an artery is joined to a vein. This is done under the skin, usually at the wrist or elbow. A fistula requires a minor surgical operation, performed under local or general anesthetic.

Since blood pressure in arteries is higher than in veins, when a fistula is formed the vein enlarges. It usually takes about 6 weeks from the operation for the fistula to "mature", that is, to grow and strengthen. It is then ready to be used for dialysis.

When the fistula is mature, the arm in which it is formed can be used as usual, although patients should protect the arm with the fistula from knocks and pressure so as to keep it in good working order.

Specifically, patients should avoid:

wearing tight clothing or a wristwatch on the arm with the fistula
having blood pressure taken on the arm with the fistula
having blood samples taken from the arm with the fistula (except during Haemodialysis treatment, or with the renal dialsis cemter's approval)
sleeping on the fistula arm
carrying heavy shopping bags on the fistula arm

Patients are shown how to check their fistula daily to ensure that it is working. They are advised to inform their renal center if they are worried that the fistula may not be working.

Some patients, particularly children or those with diabetes have blood vessels that are not strong enough for a fistula. They will need a permanent catheter for hemodialysis access. (A mature fistula allows immediate dialysis)

May 1, 2006

Next: Haemodialysis catheters