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Maintenance and Follow-up of the Vascular Access

Examine and monitor your arm and fistula.

-         Is there edema, swelling, redness and increased temperature?

-         Is there abnormal enlargement of your fistula or graft at previous injection sites?

-         Are your fingers cold and sore?

Feel the vibration (Thrill).

-         Thrill occurs due to the effect of high blood flow passing through your fistula on the vessel wall and indicates that your fistula is working well.

-         Once your fistula is made, learn to control the vibration in your fistula.

-         To feel the vibration, gently place your fingers or palm on the area where the surgery scar is located and try to feel the vibration.


How should dialysis be performed for fistula?

-  Wash your fistula arm with soap on the morning and before dialysis.


Preparation for needle insertion:

-         If needle insertion is extremely painful and uncomfortable for you, local anesthetic creams can be applied to this area. Consult your dialysis physician on this matter.

-         Your dialysis nurse will clean your skin with an antiseptic solution.

-         Never touch the cleaned area without a needle inserted.


Attaching needles:

In order to undergo dialysis with your fistula or graft, 2 needles need to be inserted for each dialysis:

-         With an arterial needle (red color), your blood is taken from your fistula into the machine and directed to the dialysis filter.

-         Venous needle (blue needle) cleaned blood is returned to your body through your fistula.

-         Thicker needles allow for higher amounts of blood to be drawn.

-         If your fistula has just started to be used, thinner needles are preferred. These needles create less pressure on your fistula and prevent premature damage to your fistula.

-         Needles should be applied at least 3 cm away from the operation site. There should be a 3-5 cm gap between needles.

-         Needle locations should be changed at regular intervals. This ensures that the damage caused by the needle in your fistula is repaired.


What should I do after the dialysis session is over?

If you have a fistula or graft:

-         After dialysis is finished, your dialysis nurse removes both needles from your fistula.

-         Apply finger pressure directly to the needle insertion area using sterile gauze. After a while, the bleeding stops. This may take about 3-10 minutes. The nurse then leaves it up to you to apply pressure. Excessive pressure should not be applied at this time. Because:

-         Bleeding does not stop faster with excessive pressure.

-         When full pressure is applied, no blood flow can pass through your fistula.

-         This may cause a clot in the fistula and lead to the loss of your fistula.

-         If your bleeding lasts longer than 30 minutes, report this to your dialysis doctor.

-         Large gauze should not be used for this procedure.

-         Both needle sites should be covered with a plaster over small gauze.

-         The patch dressing should be gently removed after remaining in this area for 3-5 hours.

-         The patch and bandage should not suffocate your arm.

-         Do not leave the dialysis center until bleeding stops completely.

-         If bleeding occurs after leaving the center, do not panic and apply appropriate pressure to the injection sites with clean gauze.

-         It is a good idea to have 1-2 sterile gauze with you for this situation.


Is there a problem with my fistula?

Some problems may develop in your fistula and graft without you being aware of it. For this reason, you need to be knowledgeable about the problems in fistula. The first findings that suggest that there is a problem with your fistula are:

-         The nurse has difficulty inserting a needle.

-         Clot formation when the needles are first inserted.

-         Insufficient blood flow during dialysis.

-         Increased pressures in dialysis lines.

-         Prolonged bleeding time after needles are removed.

-         Detection of insufficiency in cleaning the blood in monthly blood tests


I have these findings, what should I do?

-         If the above conditions occur, be examined by your vascular surgeon. After the examination, if necessary, he/she gives you detailed information about the status of your fistula with Color Doppler Ultrasonography examination. This condition is usually due to narrowing or clot formation in your fistula.

-         In this case, he/she will ask you for Fistulography examination.


What is fistulography?

Fistulography is a special imaging method performed with an angiography system.

-         It is performed by radiologists in the Angiography Laboratory.

-         Preparation for fistulography is similar to preparation for catheter insertion or surgical intervention.

-         It is applied under local anesthesia and sedative drugs. You will be awake during the procedure.


How is fistulography performed?

-         The skin over your fistula is cleaned with betadine solution.

-         A needle, similar to dialysis needles, is inserted into your fistula or artery.

-         Medicine containing a small amount of contrast material is given through this needle.

-         Meanwhile, the device switches to imaging and creates images of your artery and fistula.

-         Stenosis and blockages in your fistula or graft are detected.

-         If necessary, stenosis areas are expanded with Balloon Treatment in the same session.

-         Sometimes a stent is placed to prevent stenosis from occurring again in the expanded area.

-         If necessary, blood thinning medications are given.

-         Fistulography takes approximately 15-45 minutes.


Post Processing:    

-         You will be kept under observation in the surveillance room for a while.

-         You can then return home or to your dialysis centre.


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