Getting Ready for a Fistula or a Graft Placement
Getting a fistula or graft placed is part of getting ready for hemodialysis. A fistula or graft is the preferred access for dialysis. This list outlines things you need to do to get the dialysis access.
Begin to protect your arm. If you are right handed, your surgeon’s first choice is to place the access in your left arm. If you are left handed, the right arm will be the surgeon’s first choice. There are times when this will not be the case. Your surgeon will tell you which arm to protect. Tell people not to use that arm for IV’s, needle sticks for lab work, or checking a blood pressure.
Ultrasound mapping. Some patients may need studies to check the size of the blood vessels before the access placement. Ultrasound mapping of the arm is one useful tool to assist the surgeon in planning for access. There are no needles involved when mapping is done.
Venogram. Some patients may need a study called a venogram. In this study, a needle is used to inject dye into your blood vessels. The Access Team will decide which study is best for you.
Access Clinic. At this visit, your access options will be discussed with you. The Access Team will decide the best type of access for you based on your exam and any tests you may have had. After that, you will go to the Outpatient Surgery Center to discuss anesthesia. You will NOT have surgery on this day. Your surgery will be scheduled within 30 days of this visit. You do not need to hold your medicines or insulin, or skip breakfast for this visit.
Surgery. A fistula or graft is placed in the operating room. This will take about 1 to 2 hours. You will be watched after surgery until you are ready to go home (most often in 1-3 hours). You must have a ride to and from the hospital. You cannot drive after getting medicine for pain. You must also have someone who can stay with you during the first night.
After surgery teaching. Before you leave, your nurse will give you a handout about how to take care of your new fistula or graft. It is helpful if your driver can be with you when the nurse reviews these instructions. You may take your arm out of the sling after you get home. Prop it on a couple of pillows to decrease swelling when you are sitting in a chair or in bed.
Return to the clinic within 3 weeks after your surgery to have your new access checked.
Call your kidney doctor if you begin to notice symptoms that concern you.
- Severe pain
- Swelling with numbness or tingling
- Redness and heat or drainage at the incision site
- Fever above 100° F
- Bleeding from the wound that doesn’t stop
- Pale or purple cold fingers
You may contact your kidney doctor by calling (608) 270-5656 between the hours of 8-4:30 Monday - Friday. After hours, on weekends or holidays, please call the same number and follow the answering machine instructions. If you cannot contact the doctor for any reason, go to the nearest Emergency Department.
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: 10/01/2010
Copyright © 10/01/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6640
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