Daily life fistula care

Fistula Check

Given that the fistula plays a key role in a successful dialysis treatment, it is really important to keep it in good condition. Your fistula needs checking every day! You should use your  eyes, ears and fingers to check that everything is OK.

When looking at your fistula arm, be aware of any signs of redness or swelling.

One way to check if there is a good blood flow through the fistula is to use a stethoscope in order to hear a sound called “bruit”. Ask your dialysis team to show you how to do this.

The easiest way is to put your hand on your fistula. You should feel a rhythmic vibration / buzzing sensation called a “thrill”. When palpating your fistula, pay special attention if it feels sore or warmer than usual.

Please follow a couple of simple rules to minimise the danger of infection or thrombosis, which are the most common dangers for your fistula:

Let the blood move freely

Avoid pressure of any kind on your fistula arm, as it can lead to thrombosis, especially in a condition of low blood pressure. You should avoid the following:

  • Wearing tight clothing or restricting objects such as watches or bracelets which could cause a compression of the fistula.
  • Sleeping on your access arm, as it can lead to transitory fistula kinking and a reduction of the blood flow.
  • Strong bending of your fistula arm.
  • Measuring your blood pressure in the fistula arm with a blood pressure meter, as inflating the cuff induces a compression of the blood vessels.
  • Drawing blood or injections, as afterwards haemostasis has to be performed. In addition, unqualified personnel could potentially damage the fistula.

If you notice any of these disturbing symptoms: redness, swelling, soreness, increased temperature in the fistula area, please contact your doctor or dialysis team immediately.

Keep it clean

In order to avoid any possible bacteria migrations from the skin to the blood circulation system, which could lead to infection, always remember to:

  • Wash the access site with water and soap reserved for that purpose only every day and before each dialysis session.
  • Avoid coughing or sneezing in the direction of the fistula.
  • Refrain from scratching the fistula area and particularly the access sites.

Protect it from injuries

  • Avoid activities that might cause injuries to the fistula such as lifting heavy objects like suitcases or packing cases. For instance, when shopping take a trolley instead of a basket and don’t use your fistula arm to carry your heavy grocery bags home.
  • Do sports which do not over-burden your fistula arm, for example jogging or cycling.

Be careful of temperature extremes

Very high or low temperatures can also have adverse effects on your fistula and lead to thrombosis. It is recommendable not to expose yourself to:

  • Excessive heat (e.g. sauna or sweat baths), as it induces vessel dilation and reduces the blood pressure and blood flow. If you want to be outside on a very hot day, try to stay in the shade.
  • Excessive cold. This induces vessel constriction and with it reduced blood flow in the limbs, especially in the fistula arm. On extremely cold days, remember to wear appropriate warm clothes if you want to get some fresh air outside.