Question

The patient just completed a vascular “mapping” procedure with an angiogram to plan the site of an AV fistula for hemodialysis. You are considering the care priorities for the patient’s return when the AV fistula is formed.

What are important teaching points for the period immediately following AV fistula formation?

The patient asks if there is anything she can do to make this AV fistula last a long time. How should you respond to promote best practices in AV fistula self-management?

What else should this patient know about AV fistula care?

Answer 1

The immediate teaching points after an AV fistula formation are

• Report any bleeding,pain at the site,change of colours in the finger nails
• Keep arm elevated with two below at the level of the chest
• Keep the wound covered for a week
• The dressing can be removed after 48 hours ,in casinos stereo strip let it fall off on its own,if staples task a follow-up after 2 weeks to remove it.

Some of the best practices innthe management of AV fistula are

• Do soft ball exercise after 14 days ,to ensure circulation and muscle tone training
• Elected the hand while lying down at chest level and avoid hang the arm for a long time to prevent swelling
• Check for the thrill (when finger is placed on the site a slight displacement or movement cann observed) everyday to assess for any abnormalities
• Keep the site clean and dry to prevent infection
• Avoid wearing tight garments which compresses the arm
• No weight lifting for at least 3 weeks, and after that only 10pounds is allowed but it is always better to avoid it
• Avoid exercises, household choires like gardening cooking until said by doctor
• Have regular follow up
• Inform it takes about 8 to 12 weeks for ensuring patency and start on heamodialysis
• When patient is on AV fistula a high protein ,low sodium diet is recommended to prevent hypokalemia
• Inform patient not to take any OTC
• Avoid driving
• No alcohol or smoking
• Should take medication as prescribed
• The arm will be cool and numb until patency initiated ,once circulations happens this disappears
• Report immediately in case of pain,bleeding,infection and no thrill