What is a fistula?

A fistula is a surgically created connection between a vein and an artery, usually in the arm. This creates a larger, stronger blood vessel suitable for repeated needle punctures during hemodialysis.

 

Why is a fistula needed?

Hemodialysis involves removing toxins from your blood using a machine. Blood is drawn, cleaned by a filter, and returned to your body. The fistula provides reliable access for processing the large volumes of blood required for this procedure.

 

How is a fistula created?

Fistula creation is typically a minor surgical procedure performed under local anesthesia, numbing the area. General anesthesia may be used if a more extensive procedure is needed or if local anesthesia isn't tolerated well.

The fistula is usually created in the non-dominant arm (left arm for right-handed individuals), at the wrist or elbow.

A small incision is made, and the artery and vein are joined, diverting blood from the artery into the vein. Stitches close the incision; these are usually dissolvable and disappear within about 10 days. The procedure generally takes about an hour.

 

Will having a fistula leave a scar?

Yes, the surgery will leave a scar, typically no more than 4cm long, which usually fades over time.

 

What are the advantages of having a fistula?

 

Fistula makes hemodialysis easier

A functioning fistula is the best long-term access for hemodialysis. While hemodialysis lines offer an alternative, studies show fistulas offer significant advantages when feasible.

 

Hemodialysis is more efficient with a fistula

Fistulas generally allow for more efficient dialysis due to faster blood flow, leading to improved dialysis sessions and better long-term health outcomes.

 

Fistula reduces risks and complications of hemodialysis

Dialysis lines can damage blood vessels over time, hindering future line placement or fistula creation. A fistula, being internal, minimizes infection risk and allows for normal bathing, swimming, and water sports.

 

What are the risks associated with having a fistula created?

 

Fistula clotting

Blood clots can occur, requiring immediate medical attention. While often treatable, clot removal may not always be possible, necessitating alternative dialysis access.

 

Infection

Wound infection may occur, requiring antibiotics. Serious infections may necessitate antibiotic injections.

 

Arm swelling

Swelling is uncommon but can occur, particularly with complex procedures or grafts. Elevation and finger exercises can help manage swelling.

 

Numbness over the thumb

Nerve bruising during surgery, especially at the wrist, can cause temporary numbness above the thumb, usually resolving within weeks.

 

What is it like using the fistula during hemodialysis?

A local anesthetic cream is applied to numb the fistula area before two needles are inserted – one to draw blood and one to return filtered blood. You may feel a brief prick, but it shouldn't be painful.

Tubes connect the needles to the dialysis machine, allowing blood to flow for cleaning and return.

Smaller needles or a single needle may be used initially. Bruising is possible initially but usually lessens with frequent use.

 

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