Fistula hygiene: keepin' it squeaky clean

The Fistula: Care and Monitoring

***Protecting Your Access Site: Simple dos and don'ts for taking care of your fistula or graft to prevent injuries (e.g., avoiding tight clothing or heavy lifting). [1, 2]

Hello Everyone! 

Today I'm going to talk to you about fistulas and how to keep them clean and safe. It's important to know how it looks and works normally(and when it doesn't). I have to be honest, I didn't know a lot of this stuff before I wrote this post, so I'm learning with you!

Protecting your dialysis access site is essential to prevent infections, clotting, and injury. The most important rule is to treat your access arm as a "safety zone"—never allow anyone to draw blood, start an IV, or measure blood pressure on it. [1, 2, 3, 4, 5]

Fistula or Graft Arm Care for Dialysis Patients:

🛑 What to AVOID (Don'ts):

• No constrictions: Avoid tight clothing, watches, or bracelets over the access site.
• No heavy lifting: Do not carry heavy bags or lift more than 10 pounds (4.5 kg) with the access arm.
• No sleeping on it: Never sleep with your head or body resting directly on your access arm.
• No pressure: Avoid leaning or resting on the arm where the access is located.
• No scratching: Never pick at scabs or scratch the needle sites. [1, 2, 3, 4]

🟢 What to DO (Dos):

• Check the flow daily: Lightly place your fingers over your access once or twice a day to feel for a gentle pulse or vibration, known as the "thrill".
• Keep it clean: Wash the area daily with warm water and antibacterial soap, especially before your dialysis sessions.
• Rotate your needle sites: Ask your dialysis care team to change the exact location where needles are inserted each treatment.
• Protect the skin: Use loose-fitting shirts or sleeves that don't rub against the area. [1, 2, 3, 4, 5]

🚨 When to Contact Your Doctor Immediately [1]:

If you notice any of the following, call your care team or doctor right away: [1]

• You can't feel the "thrill" (vibration), or the flow suddenly changes.
• Signs of infection (e.g., redness, swelling, warmth, or pus).
• Numbness, tingling, or pain in your access hand or arm.
• Uncontrolled bleeding from the needle sites after dialysis. [1, 2, 3, 4, 5]

For more comprehensive guidelines and patient safety information, visit the National Kidney Foundation Hemodialysis Access Guide or the Centers for Disease Control and Prevention Dialysis Patient Pocket Guide 

Self-Examination Techniques for Fistula Health:

• Get into the habit of checking your access site several times a day: [1, 2]

• Look: Inspect the skin for any new redness, swelling, oozing, or warmth.

• Feel: Place your fingers lightly over the fistula.

• You should feel a steady, gentle vibration or pulse called the "thrill".

• Listen: Use a stethoscope to listen to the "bruit"—a consistent whooshing sound made by blood flowing through the fistula. [1, 2, 3, 4, 5]

Self-Examination of your dialysis graft: Perform the "Look, Listen, and Feel" test daily to ensure it is working properly and has good blood flow. [1, 2]

1. LOOK: Inspect the skin over and around your graft site every day. [1, 2]

Normal: The skin should look like the rest of your arm without any changes in color.

Warning Signs: Call your care team immediately if you notice any redness, swelling, oozing, rashes, scabs that won't heal, or parts that are ballooning out. [1, 2]

2. LISTEN: Use a stethoscope to listen along the entire length of your graft. [1]

Normal: You should hear a steady, low-pitched "whoosh," "swoosh," or gentle humming sound. This is called a bruit.

Warning Signs: Call your care team immediately if the sound changes pitch (like a high-pitched tea kettle), suddenly becomes much louder, or if you hear absolutely no sound. [1, 2, 3, 4, 5]

3. FEEL: Place your fingers lightly over the graft. [1]

Normal: You should feel a steady, continuous buzz or vibration. This is called a thrill.

Warning Signs: Call your care team immediately if the buzzing stops, becomes very weak, or feels like a hard, throbbing pulse instead of a smooth vibration. [1, 2, 3, 4, 5, 6]

Important Reminders:
Never let anyone take your blood pressure, draw blood, or start an IV on the arm with your graft. Additionally, protect the graft by avoiding tight clothes, jewelry, and heavy lifting with that arm. [1, 2, 3]

What to Avoid During Dialysis:

• Dialysis Access Care Guidelines

Managing Access Site Scabs

• Access Location Scabs: Don't scratch, pick at, or take off scabs from the dialysis needles.

• That could cause a lot of bleeding or let in bacteria.

Hygiene of Healthcare Providers

• Dirty Hands: Make sure your dialysis team has just washed their hands and put on fresh gloves before they touch your access.

Proper Bandaging Techniques

• Bandage Wrapping: Don't wrap bandages, gauze, or tape all the way around your access arm.

• That can cut off blood flow and make your fistula clot.

When to Call Your Doctor:

Dialysis Access Complications and When to Seek Help

Warning Signs of Access Issues

• Redness, swelling, or pus leaking from the needle sites.

• A fever.

• The buzzing vibration or whooshing sound is weaker, changed, or completely stops.

• The needle sites bleed for a long time after your treatment finishes. [1, 2, 3, 4, 5, 6]

Immediate Action Required

• Contact your medical or dialysis team immediately if you notice: [1, 2, 3]

Here's my personal take (I'M NOT A PROFESSIONAL):

My awesome CCHT/PCTs and nurses always taught me it's best to take off those bandages (the ones they put on to stop the bleeding) the next day.

Sometimes, my access site bleeds a little right after I take the bandages off. That's actually pretty normal. Usually, it's because the bandage pulls at the scab that's formed on one or both of the access sites. I just pop a band-aid on it and check back in an hour or two. It's usually all closed up by then.

I'm totally guilty of leaning on my fistula arm. I'm a lefty, so I tend to lean on my right side when I'm sitting, especially when I'm working. I really need to change how I sit. And I gotta watch out for heavy lifting!

Now, I already knew about the "NO ACCESS FOR ANYTHING" rule for the fistula site. I make it a point to tell all the medical pros (nurses, doctors, and technicians) that it's a "NO GO" area. If you make a habit of letting people know, it'll be easier to have a good chat and set boundaries about your fistula (AVF).

I love the terms used to describe a fistula's heartbeat. "Thrill" is a good name for the buzz you feel over a vascular access site. I hadn't heard of "bruit" before (it's pronounced "brew-ee" and is an audible, whooshing sound from turbulent blood flow).

I didn't realize that wrapping bandages around your whole fistula could cause blood clots. That's good to know because we often have to add more tape at home due to wear and tear (like when you rub your site against things and the tape pulls away).

A friend of mine who's also a patient told me something helpful the other day: try to get your fistula low on your forearm or wrist. That's because if/when the surgeon has to move your access port, they go up your arms, then to your chest. (There's a more detailed explanation below.)No matter your situation, good hygiene is super important to make sure your access site is ready for dialysis treatments. 

Have a great weekend and enjoy the nice weather. May your day be filled with wonder and joy! I hope your day "shines like the top of the Chrysler Building!" (-from the musical Annie)

Tina

Surgical Options for Dialysis Access Creation and Re-Routing:

• When re-creating a fistula, a vascular surgeon will typically move higher up the same arm or switch to the other arm.

• If veins in both arms are used up, they may reroute a deep arm vein to the chest, or occasionally use a synthetic tube (graft). [1, 2, 3]

• For a closer look, the procedure generally follows these steps:

• Moving Up the Arm: If a lower-arm fistula fails, the surgeon usually moves to the upper arm.

• They will connect an upper-arm artery to a larger vein near the bicep or inside the elbow. [1, 2, 3]

• The "Transposition" Method: If the best superficial veins are unavailable, the surgeon will use a deeper vein (the basilic vein).

• They will lift and reroute ("transpose") this deeper vein closer to the skin's surface so it can be easily used for needles. [1, 2, 3]

• Chest or Neck Options: If the arms are not an option, they may use a different vein (or a synthetic tube) in the chest.

• Neck areas are generally reserved for temporary catheters, not permanent fistulas. [1, 2, 3, 4]

Pre-operative Assessment and Resources

• Before any surgery, your doctor will perform a vein mapping (an ultrasound) to determine the best available blood vessels.

• To learn more about how they evaluate and plan your access, you can visit the National Kidney Foundation on dialysis access. [1, 2, 3]

Links to fistula care sites:

National Kidney Foundation (hemodialysis fistula care)

Home Dialysis Central

DaVita Fistula Care

Here's my quote for the day:

"Healing involves discomfort. But so is refusing to heaI. And over time, refusing to heal is always more painful." -Resmaa Menakem

My personal links are in the sidebar.

(Please, please,  please share these links with everyone!)

Thank you for reading my posts.