Arteriovenous (AV) Fistula for Dialysis

An AV fistula is a connection between an artery and a vein. For this procedure, an AV fistula is surgically created using an artery and a vein in your arm. (Your doctor will let you know if another site is to be used.) When the artery and vein are joined, blood flow increases from the artery into the vein. As a result, the vein enlarges over time. The enlarged vein provides easier access to the blood for dialysis (a treatment for kidney failure). This sheet explains the procedure and what to expect.

Forearm and hand showing vein and artery connected by stitches. Arrow shows blood flow going from artery to vein.

Preparing for the Procedure

Prepare as you have been told. In addition:

  • Tell your doctor about all medications you take. This includes over-the-counter drugs. It also includes herbs and other supplements. You may need to stop taking some or all of them before the procedure.

  • Follow any directions you’re given for not eating or drinking before the procedure.

  • Do not allow anyone to draw blood from or take blood pressure on the arm that will have the fistula prior to the procedure.

The Day of the Procedure

The procedure takes about 1-2 hours. You’ll likely go home the same day.

Before the procedure begins:

  • An IV line is put into a vein in the arm or hand not being used for the procedure. This line supplies fluids and medications.

  • To keep you free of pain during the procedure, you’re given general anesthesia. This medication puts you into a state like deep sleep through the procedure. Or a nerve block may be used. This medication numbs the arm. With it, you may also be given medication that makes you relaxed and drowsy through the procedure.

During the procedure:

  • The skin over your arm may be injected with numbing medication.

  • One or more small incisions are then made through the numbed skin. This depends on the size of your arm and the depth of the vein in your arm.

  • The vein is attached to the selected artery.

  • Any incisions made are then closed with sutures (stitches), staples, surgical glue, or strips of surgical tape.

After the procedure:

  • You’ll be asked to keep your arm raised (elevated) as often as possible for at least a week after the procedure.

  • You’ll be given medications to manage pain as needed.

  • Your arm and hand will be checked to make sure blood is flowing through the fistula properly. The feeling of blood rushing through the fistula is called a thrill. It is somewhat similar to the purring of a cat. You’ll be taught how to check for this feeling each day to make sure there are no problems with your fistula. You’ll also be taught how to care for your fistula at home.

  • When it’s time for you to leave the hospital, have an adult family member or friend ready to drive you home.

Recovering at Home

Once at home, follow all of the instructions you’ve been given. Be sure to:

  • Take all medications as directed.

  • Care for your incision as instructed.

  • Check for signs of infection at the incision site (see below).

  • Avoid heavy lifting and strenuous activities as directed.

  • Monitor and care for your fistula as instructed.

  • Do your hand and arm exercises as instructed. This usually involves squeezing a ball in your hand for a few minutes each hour.

Call Your Health Care Provider If You Have Any of the Following:

  • Fever of 100.4°F or higher

  • Signs of infection at the incision site, such as increased redness or swelling, warmth, worsening pain, bleeding, or foul-smelling drainage

  • Lack of a thrill (you can’t feel it)

  • Pain or numbness in your fingers, hand, or arm

  • Bleeding, redness, or warmth around your fistula

  • Sudden bulging of the fistula (more than usual; a slight bulge is normal)

Follow-Up

Your health care provider will check your fistula within 1 to 2 weeks after the procedure. It will likely take about 6 to 8 weeks for the fistula to enlarge enough to start dialysis. After that, make sure the fistula is checked each time you have dialysis. Your health care provider may also suggest checkups every 6 months.

Risks and Possible Complications Include:

  • Failure of the fistula to work properly

  • Long wait before the fistula is ready (up to 6 months)

  • Coldness or numbness in the hand (due to blood flowing away from the hand and into the fistula)

  • An unsightly bump under the skin (due to enlargement of the fistula)

  • Prolonged bleeding from the fistula after dialysis

  • Narrowing or weakening of the blood vessels used for the fistula

  • Formation of blood clots in the blood vessels used for the fistula

  • Risks of anesthesia or any other medications used during the procedure

Living with an AV Fistula

A problem, such as narrowing of the vein (stricture) or infection, can make the fistula unusable. If this happens, you may need other treatments to repair or make a new fistula. To protect your fistula, follow these and any other guidelines you’re given:

  • Check your fistula as often as your health care provider says. If you can’t feel your thrill, let he or she know right away.

  • Make sure your fistula is checked before each dialysis treatment.

  • Don’t let anyone draw blood from or take blood pressure on the arm that has the fistula.

  • Wash your hands often and keep the area around your fistula clean.

  • Don’t sleep on the arm that has the fistula.

  • Don’t wear tight jewelry or a watch on the arm with your fistula.

  • Protect your fistula from cuts, scrapes, or blows.



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