3rd Dialysis patient class
Topic: fistula care
Why do dialysis patients need fistulas?
It is important to send plenty of
the patient’s blood to the
machine to be cleaned for a
limited time (usually 4 hours).
It’s not easy to do it using our normal blood vessels.
First let us learn about our normal blood vessels, and then
learn about fistulas.
We have two kinds of blood vessels
Arteries: Blood vessels send blood
from the heart to the body.
Their walls are thick and strong
because blood is flowing with a
strong force in these vessels.
They run deeper in the body
Veins: Blood vessels send blood from
the body to the heart.
Their walls are thin and soft because
blood is flowing gradually in these
vessels.
They run close to the body’s surface.
This is a fistula!!
This artery and this vein
will be joined by surgery.
This is a fistula.
Blood will be flowing with a strong force from the artery into
the vein which is running close to the surface.
It will be possible to send a large volume of blood to a dialysis
machine with placing a needle in the vein(fistula).
The fistula can usually be used for several
years- even more than 10 years.
Sometimes it might cause complications or fail
sooner.
Let’s study about fistula care in order to
keep your fistula in good condition for a
long time.
Daily care of fistula.
Important points
Not to block the fistula flow.
Not to cause bleeding or internal bleeding.
Prevent infection.
Essential care
Check the vibrations (it’s called thrill) by touching it
with your hand at least 1-2 times a day.
Feel the vibrations
Don’t put your head
on your fistula arm.
Don’t hung a bag
on your fistula
arm.
Don’t lie with your
fistula arm under your
body.
Don’t put
anything heavy
on your fistula
arm.
Don’t take blood
pressure on your fistula
arm.
Don’t take a blood sample
from your fistula arm
except at a dialysis time.
Don’t put a
watch on your
fistula arm.
Don’t wear tight-sleeved clothes.
Don’t hit your fistula.
Don’t knock your fistula against anything.
Keep your fistula arm
clean.
Don’t scratch fistula arm.
If you get a rash on your
fistula, show it to a
dermatologist and start
treatment soon.
If your fistula is thin, do the following exercise.
It is desirable to do this as frequently and for as long as
possible.
<Holding a soft ball>
You can start this the day after
the operation.
<Bending and stretching of
the elbow>
You can start this one week after the
operation.
Before coming for dialysis treatment
Wash and clean your fistula arm from tip of finger to the top
of the arm.
Dialysis treatment time
Prevent BP falling.
Call nurses and request them to check BP
when you feel.
<Signs of BP falling>
nausea
vomiting
rapid heartbeat
yawning
feeling hot
sweating
Removing too much fluid easily causes low BP, and
reduces the blood flow in a fistula. Then, the fistula
might weaken or collapse.
normal BP
Low BP
Very low BP
of
la.
The pressure in the
fistula is enough to keep
it in good condition.
The pressure in the fistula is also low, and
not enough to keep it in good condition.
This sometimes causes permanent fistula
failure.
Also
Removing too much fluid makes the blood thick, and
might cause a thrombus in the fistula. (especially when
the patient has high hematocrit and hemoglobin.)
Have you forgotten?
The recommended weight gain limit
between each dialysis treatment is less
than 6% of DW (target weight).
The fluid intake for dialysis patients should be less
than urine output + 500ml per day.
Control your fluid intake.
Don’t let us prick with the needles in the same place
every time.
Pricking in a new place is little bit more painful and
difficult for the nurses, but it good for the fistula.
Please understand this.
Why is it bad for the fistula to prick the same
place every time?
If we prick in the
same place many
times,
Fistula wall
also becomes
thin and very
weak!!
Skin becomes
worn and
weak.
High blood flow
pushes at the
weak place.
A lump
is made.
High blood flow from artery
Then, germs can easily enter from the weak place of the skin
and fistula wall into the blood, and might move to other
places.
Blood can carry the germs
to every part of the body.
To the heart
To the brain
To the joints
To all places in
the body(sepsis)
If we continue to prick the
lump…
Someday,
might occur.
Pricking on the same place might cause
stenosis.
After dialysis
Press the sites after taking out
needles in the proper way.
*If you can’t press the sites properly, this might cause
bleeding, internal bleeding or haematoma.
These sometimes cause permanent fistula failure.
*If you touch the sites with dirty hands, the patient might
get infection.
Clean your hands and protect your patient from
germs.
You might need to wear
gloves for some patients.
・Put one hand on one site.
Use both hands.
・Use 2 or 3 fingers of each hand.
・Lay your fingers flat.
Don’t use the tips of your
fingers.
※This is the basic way. It will not always be effective for all
patients.
It is important to press covering both holes situated a
little way apart.
One hole is on the skin.
One hole is on
the fistula wall.
So use 2-3 fingers on the
site, lay the fingers flat,
then press on both holes.
・Press a little strongly
for 2-3 min.
・After that, gradually reduce
the pressure for 5-10 min.
・Bleeding will usually stop in this way.
・Change the gauzes to small clean ones.
The following methods are not recommended.
When using these ways, it is easy to move the sites of
the fingers and fail to stop the bleeding.
Using finger tips
Using only one
finger for one site.
Using only one hand.
Watching TV.
If the patient needs to do the pressing himself, as each
needle is removed, he should deal with each site
separately.
This method is most successful.
Take the gauze pieces off the next
day.
If you don’t remove the gauze, it might get dirty
and cause infection.
Germs like blood and wet places.
What should you do in these
following cases?
Internal bleeding or swelling
Cool the place for that day.
Warm the place from the next day.
Check the thrill(vibration) very
often.
※
Too cold or too hot can cause frostbite or
scalding.
Check your skin during cooling and
warming very often.
In this case, blood is bleeding under the skin. Cooling helps to stop
bleeding and absorb the leaked blood into subcutaneous tissue.
Cannot feel thrill(vibration)
1
2
3
Lie down on bed, and your
BP will rise.
Low BP often causes fistula
weakness.
Massage and warm your
fistula.
If the thrill does not return,
show to nephrologist or
dialysis nurse.
Complications of fistula
These following cases need to be shown to a
nephrologist.
High venous blood pressure
If upside of fistula is closed or
very narrow, a lot of blood
from the artery cannot return
to the heart.
Then, that blood
goes down to the
hand, and stays
there, causing
swelling.
Sore thumb/sore hand syndrome
If ‘High venous blood pressure’ becomes worse, it
causes finger or hand pain.
It sometimes causes
ulcers on the fingers.
Steal syndrome
If most of the blood that
should be sent to the hand
or fingers goes to a fistula,
then the hand or fingers
cannot get enough blood.
Coldness, numbness or
pain may occur.
In a serious case,
ulcers may occur.
aneurism
Not all aneurism are dangerous.
Show to nephrologist in the following cases.
It is glossy.
It is growing rapidly.
There is a risk of aneurism rupture
in these cases.