A fistula is an artificially created fistula that directly connects the artery and vein for subsequent hemodialysis processes. The essence of creating a fistula is reduced to surgical intervention, during which the doctor forms an arteriovenous aneurysm.
It will connect the artery with the peripheral vein. Prior to the introduction of the technique, chronic kidney failure was reckoned as a diagnosis, with 100% leading to death. Today, pathology can be treated.
Objectives of the procedure
The goal of the fistula is to provide chronic dialysis. Thanks to access to blood vessels, blood is purified. Such access is an opening, through which it is possible, both to remove blood and to pour in a large volume.
The result is a thickening of the veins, an increase in the speed of blood circulation among them. Thanks to a fistula for hemodialysis, it is easier for a patient to connect an artificial kidney.
The fistula connects the vein with the artery on one arm, the result is a vessel with good blood circulation, optimally thick walls. This is a superficial vessel, which the doctor can conveniently puncture to purify the bloodstream.
Arteries are blood vessels that circulate blood, but they are deeply localized, so it is difficult to perform a puncture. The veins are located closer to the surface of the body, they are distinguished by their accessibility, small thickness, but the circulation of blood on them is small. Therefore, the combination of these vessels solves the problem.
Features of fistula
Like all medical manipulations, fistula has advantages.
- The fistula is located under the skin, which means that it is easily accessible;
- A fistula is formed only from the tissues of the patient himself, so problems with rejection will not arise;
- Risk of thrombosis, infection reduced to almost zero;
- The system can be used for years, decades;
- Ways of installing the fistula are regularly improved, which makes the procedure more safe and comfortable.
- Ripen fistula long enough – about 2 months or more, this is considered the main disadvantage of the procedure;
- A fistula may not ripen due to low blood pressure, small blood flow, small vessel sizes selected for stitching.
The disadvantages are less than the benefits, and given that the procedure saves lives for patients, the disadvantages can be ignored.
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Preparing for the procedure
How to install a fistula doctor directs the patient for diagnosis – you need to go through a series of studies to find out the state of health. Evaluation of the work of the heart, blood vessels, kidney function.
The complex of activities includes:
- Diagnosis of the heart for functionality;
- ultrasound examination of the heart, kidneys, vessels;
- blood tests for HIV, hepatitis;
- OAM, UAC;
- X-ray of the sternum;
- Hepatic-renal complex.
The complex of diagnostic measures is considered an important stage in the preparation for the operation. Based on the results of the diagnosis, doctors reveal the state of the balance of electrolytes and proteins. If there are deviations, correct. Before the operation, it is necessary to normalize the level of hemoglobin in the body.
The patient notifies the doctor about all medications taken, some medications may interfere with the normal operation. The doctor will decide whether to stop taking medication.
It’s about blood thinning, anti-inflammatory drugs.
The successful outcome and recovery of the patient depend on the correctness of the operation. The veins with the artery are stitched on the forearm. This area is considered the most convenient for puncture, so choose it.
The result will be a vessel close to the surface of the body with a blood flow and thick walls to withstand the subsequent punctures for hemodialysis. The stages of the procedure are as follows:
- Treatment of the site of operation by antiseptic, aseptic means;
- The artery is exposed, bandaged, intersected;
- The lateral vein is mobilized, clamps are applied;
- Vein and artery are dissected, then sewn;
- On the wound of the forearm are superimposed seams;
- A dressing is applied.
Proper care of the fistula begins before surgery. To form a fistula, a sufficient development of blood vessels is necessary; therefore veins on the forearm should be protected, not punctured.
Dialysis will begin after the ripening of the fistula, guarantees quality, a long period of work. To prolong the time of operation of the fistula for hemodialysis, observe the recommendations:
- After the operation, you need to give the armrest. It is advisable to keep her more time on the dais;
- When enough time passes, the doctor will allow you to load your arm with a fistula, but not excessively. It is important to avoid inactivity and overload;
- Dry the fistula daily;
- It is important to listen to the noise from the fistula. He should not change cardinally, if that happens, it’s time to see a doctor;
- Observe hygiene measures;
- To exclude sleep on the arm with a fistula;
- Monitor blood pressure, not allowing sharp jumps;
- The hand with a fistula is not used for blood sampling for analysis, pressure measurement.
The patient will have to constantly monitor the condition of the fistula. It’s not difficult; it’s a habit, like brushing your teeth. You need to visually and to feel whether everything is in order.
Swelling, redness of the skin – abnormalities, if such changes are revealed, you should immediately consult a doctor. With the help of a stethoscope, you can hear the noise inside the fistula, assess the speed of blood flow. The doctor will explain what to look for.
Gently touching the site of the operation, the patient will not do any harm. Vibration is a normal sensation, pain from touching should not be.
Rules for the care of a fistula for dialysis include, among other things, hygiene. The site where the surgical procedure was performed was washed with water at room temperature, soap was used specifically, and then it was taken away in a separate soap dish, so as not to be used on other parts of the body.
Cleaning is necessary before dialysis. You can not scratch a site with a fist, otherwise, you can put an infection. The same can be said about sneezing and coughing in the direction of the operated arm – such moments should be avoided.
Sports for the body are used. Patients with fistula are allowed to run, ride a bicycle – this will not damage the seams, vessels. But we do not need to lift the heaviness with an operated arm, so power sports are excluded. Enemy fistula acts as a strong frost and a hot ambient temperature.
Both variants are fraught with thrombosis. Visiting the sauna leads to the expansion of blood vessels, reducing pressure. The result is a slower flow of blood. Therefore, in order to preserve one’s own health, one should refuse visits to a sauna, a sauna, and in the summer it is desirable to stay in the shade.
The above recommendations will avoid complications, maintain fistula in working condition for regular dialysis. Specific recommendations each patient receives from his attending physician.