Caring for the arteriovenous fistula in dialysis

Caring for the arteriovenous fistula (AVF) is essential for the health of patients on dialysis. It could be described as a lifeline, precisely to underline how important it is for people treated with dialysis using an artificial kidney. In hemodialysis, we can identify three types of vascular access:

• Native AVF, created with the patient’s own vessels;
• Prosthetic AVF (graft), created using synthetic or semi-biological material;
• CVC – central venous catheters.

Caring for the arteriovenous fistula

There are guidelines for the care of the arteriovenous fistula. Those set by the IFK, the worldwide kidney foundation, and the European ones. The European best practices (EBPG) tell physicians how to create and care for the arteriovenous fistula. Statistically, at least 50% of dialysis patients have an AVF, because the goal is to limit the use of both grafts and central venous catheters. The latter should be the last possible solution when there are diseases due to comorbidities. Or when there are no blood vessels left available for creating an arteriovenous fistula. 

A bridge while waiting

A bridge, that is, a connection, is the most appropriate use of the central venous catheter. All this while waiting for the creation of an AVF, whether native or prosthetic. The CVC can also be used in patients whose health is so serious that the AVF cannot be created immediately, and it is therefore necessary to wait for better clinical conditions.

Italy in first place

Italy has a record to its name: it has the highest number of prevalent patients with an AVF. According to the study carried out by DOPPS (Dialysis Outcomes and Practice Patterns Study), Italy is the country with the highest presence of AVFs among patients. It is dominant compared with Spain, France, Germany and the United Kingdom. This is a clear finding, because it has been established that patients with an arteriovenous fistula have a longer life expectancy. This is why worldwide and European best practices urge making every possible effort to create the AVF.

Complications in dialysis patients

The DOPPS III study confirms that patients with a graft vascular access have more complications than those with an arteriovenous fistula. Survival increases by 53% at 5 years and by 43% at ten years in patients who receive a native AVF. In patients with a graft, the survival data are as follows:

• 1 year: 67% of patients survive;
• 2 years: 50% of patients survive;
• 3 years: 43% of patients survive.

Factors that increase complications in patients with an arteriovenous fistula

The efficiency of the AVF and life expectancy after vascular access are affected by several factors, which play a decisive role. They are:

• Atherosclerosis
• Comorbidities
• Diabetes
• Age
• Previous cardiovascular events
• Late referral (late referral to the nephrologist)
• Peripheral vascular disease
• Obesity
• Smoking

Information for patients

Health care staff are essential in the care of the arteriovenous fistula. At Nefrocenter, doctors and nurses are selected to guarantee patients the highest possible level of care. In addition, the group periodically runs refresher courses, not only to improve patient service but also to put into practice the best treatments that medicine offers worldwide. The evolution of dialysis care (and of other fields as well) has a company study area that includes the best doctors: it is Nefrocenter Research. 

The patient’s role and the therapeutic pact

The patient’s behavior is essential in the care of the arteriovenous fistula, and patients must follow the instructions of the health care staff scrupulously. Self-care and prevention are essential to reduce complications. Through careful observation, it is the patient who tells the doctor about changes in the arteriovenous fistula. However, giving the patient rules is not enough. Far from it. The relationship of trust between doctor, nurse and patient helps develop an ongoing process aimed at improving quality of life and the course of treatment. A therapeutic pact is thus born between the parties, although it remains essential to have a reminder that can help the patient focus on the key aspects of AVF care.  

Reminder for the care of the arteriovenous fistula (AVF)

• Wash the AVF arm thoroughly with soap and water before the dialysis treatment.
• Do not move the arm during dialysis.
• Apply pressure to the AVF properly after dialysis, without pressing too hard.
• If dialysis is done at home, check for bleeding at the needle insertion sites. In the dialysis center, the nurse takes care of this check.
• Check for the thrill, that is, the vibration you feel when you place the palm of your hand on the fistula. Its absence calls for immediate action by the staff.
• Report any pain, warmth in the area, swelling or numbness.
• Do the exercises recommended by the health care staff to help the AVF develop.
• Avoid shirts and sweaters with sleeves that are too tight.
• Do not wear a watch on the wrist of the arteriovenous fistula arm.
• Do not measure blood pressure on the AVF arm.
• Avoid blood draws or infusion therapies on the AVF arm.
• Avoid lifting very heavy objects with the AVF arm.
• Protect the arm from accidental bumps.
• Remove the pads from the arm on the day after the dialysis treatment. If there is bleeding, follow the health care staff’s guidelines, but if the problem is not resolved with the recommended pressure, it is essential to go to the nearest emergency room.