Going Home after Dialysis Access Surgery

 

Caring for the Surgical Area

 

• You may have several small incisions in your arm.  Each will be about two inches long, with 5-6 nylon stitches.  They will be covered with a gauze dressing.
• During the first two days, sponge baths are preferred.  You may shower only if the incisions are completely covered with plastic wrap.  Do not soak your incisions.
• After two days, you may remove the original dressing and shower, but do not soak or scrub the incision until it is well healed and the stitches are removed.  Most often this is in about three weeks.  After your shower, pat the incision dry with a towel.  You may wish to leave the incision open to air or cover loosely with gauze or a large bandaid.
• Keep your arm elevated on at least two pillows to reduce swelling and soreness.  You may need to keep it raised at least 2-5 days or longer if the swelling persists.  Avoid excess motion (lifting, pulling, pushing).  If your fistula is near the elbow, avoid bending it.
• You may have a small amount of bleeding from the incision the first day.  Please tell your doctor if continuous bleeding, excess swelling or bruising occurs.
• Inspect your incision daily.  Call your doctor if any of these signs of infection occur:
  • Incision becomes red and hot.
  • Oral temperature is above 100.5° F.
  • The incision drains pus.
  • The incision becomes unusually painful.
  • Swelling occurs with numbness or tingling.
  • Blistering of the arm.
• If you also had a catheter placed, please see Health Facts for You booklet #4822, Dialysis Accesses.

Checking the Fistula

 

As long as you receive dialysis treatments, you will need to check the fistula to be sure it is working.

 

There are two ways this should be done.

 

1.     Listen with a stethoscope.  When a stethoscope is placed over the fistula, you should hear a whooshing sound called a bruit.

 

2.     Check the fistula for pulsation and thrill.  As it matures, you will be able to feel it pulsate. By placing your fingers over the fistula, you will feel the blood rushing through it; this is called a thrill.

 

Usually if the bruit decreases, the thrill also decreases.  A slower blood flow may lead to clotting. If this occurs or if you cannot hear or feel the pulsation, call your kidney doctor or the transplant clinic.

 

Precautions

 

You may use the arm with the fistula as you did before.  Be aware of the exceptions.

 

• Avoid venipuncture (blood tests, IV's, etc.) in the arm with the fistula.

• Have your blood pressure checked in opposite arm.

• Guard against direct injury to that arm.

• Check with your doctor before you return to work.

 

If you have any questions, please feel free to contact your nurse or doctor.

 

Phone Numbers 

 

Renal Transplant Clinic: 608) 262-5420, Monday-Friday, 8:00 a.m. - 4:30 p.m.

Nights and Weekends:  UW Hospital Paging Operator (608) 263-6400, ask them to page the “nephrology doctor on call.”  Give the operator your name and phone number with the area code.  The doctor will call you back.

                                                

Toll-free number 1-800-323-8942 for patients who live outside the area.

 

Spanish version is #5768

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 12/22/2009

Copyright © 12/22/2009 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #4219

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