In-centre fistula care

In the dialysis centre, the specialised professionals will take care of you and advise you about everything related to your treatment as well as your vascular access care. Here is some advice as well as a few aspects of your care you can play an active role in:

Before treatment

  • Always wash your access arm directly before treatment.
  • If an anaesthetic tape is recommended, please first wash your arm, apply the tape, then remove it and wash again before cannulation.
  • The nurse will always perform the skin disinfection before needle placement.

Cannulation and treatment time

Be receptive and open to all the information you receive from the care team about your puncture technique. There are two main techniques allowing for maximum protection of your fistula:

1. "Site-rotation” or “rope ladder”

Using this technique, for each treatment a new cannulation spot is selected, leaving some space (approx. 2 cm) from the previous one. Usually, the nurse starts cannulating at the bottom of the access until the top is reached, and then starts over again at the bottom. The whole vascular line is used. If this technique is used for you, you can help by paying attention that puncture sites are not punctured again while they are still healing, in order to prevent weak spots in your fistula.

2. Button hole” or “single puncture site”

With this technique, the needle is always placed in the exact same spot and at the same angle. In time, the needle tunnel heals, just like a pierced earring hole. This technique works best if the same person does it every time.

During treatment

  • Hold your arm still and keep it relaxed, so the needles do not get dislodged.
  • Always remember not to cover your access arm with clothes or a thick blanket, so the nurses can easily check if everything is OK.

If you are interested in being more active in the cannulation process itself, please talk to your care team about it!

Upon completion of treatment

When your treatment is completed, the needles are removed. You will need to hold the gauze on the needle sites until the bleeding stops – this process is called haemostasis. Holding your sites the right way will shorten bleeding time, prevent access damage and get you home sooner.

Here is how:

  • The nurse will put a glove on your non-access hand, or give you a sterile swab.
  • Hold firm pressure for 5 to 10 minutes with two fingers on the spots where the needles went in without peeking under the gauze. Don’t press so hard that you cut off the pulse – ask your healthcare team to show you the right pressure.
  • The nurse will indicate when the bleeding has stopped, and your haemostasis is completed. A bandage will be put on and you can take off your glove.
  • Before leaving the dialysis room, wash your hands.
  • You should take off the bandage after 3-4 hours.