Your Vascular Surgeon, Dr. Cohn, will create/ has created an Arteriovenous (AV) Fistula or AV Graft which is the site on your body where blood will be removed and returned during dialysis.  The AV Fistula is created by connecting an artery to a vein which in turns makes the vein grow larger and stronger making repeated insertions for Hemodialysis easier.  The AV Graft is created by placing a synthetic tube under your skin which then becomes the artificial vein.

Post operative information:

Please call the office at 629-7800 before leaving the hospital if you have not received a post surgery appointment date.
The following information is intended to guide you through your post-op recovery:

Diet:

For the first few days after your return home you should eat foods that you can easily tolerate.

Medications:

Follow the directions on any new prescriptions that Dr. Cohn has given you. You may return to taking your regularly scheduled medications on the day of your surgery, unless your doctor has directed you otherwise.

Pain management is an important part of your post-surgery care. You should expect some discomfort after your surgery. You will be sent home with a prescription for pain medication. It is important to take your pain medicine, as directed by Dr. Cohn, before your pain becomes severe.

Please remember:  Some side effects from the pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

Care of the incision site of your Fistula/Graft:

You may remove the initial dressing 48 hours after your surgery.

You may leave a dry gauze dressing over your incision if you have any drainage or your clothes irritate the incision.

Allow the steri-strips to come off by themselves.

Your staples or stitches will usually be removed at your 2-3 week post surgery office appointment.

Bruising and swelling of the extremity and incision is normal.

You must observe your incision daily for signs or symptoms of infection.Signs of infection include: increased swelling, redness or smelly drainage from the incision site.
 
Bathing and Showering:

You may shower after you remove your dressing which will be 48 hours after surgery. You may shower with your steri-strips in place. Do not scrub across your steri-strips. Do not bathe in a tub for 10-14 days after your surgery. This includes a “hot tub”.

Driving:

You may drive when you no longer are taking narcotic pain medications and you feel you can quickly respond to situations that will not place others in jeopardy.

Return to Work:

Dr. Cohn or his Associates should inform you of when you might return to work (usually within 1-2 weeks).

Follow-up Appointments:

You will need to return to the office for a follow-up visit usually within 2-3 weeks after your surgery. Please make sure you have your appointment scheduled.  You will then be followed monthly until the fistula is ready to access.

Problems to Observe For:
Call the office for the following:
1. Fever >101.0
2. Uncontrolled pain.  On a scale of 1-10 (10 being the worst pain imaginable) yourpain is a level 7 or above.
3. Signs of a wound infection.
4. Your incision separates- (opens up) or a staple comes out unexpectedly.                                      
5.If symptoms of numbness, tingling, weakness, and or coldness persist, without improvement, a return visit to Dr. Cohn is warranted as soon as possible as this can be a sign of a more serious problem.                                


Information and Care of the new fistula

The fistula or graft cannot be used until Dr. Cohn has given approval.  Generally, a graft can be ready to use in 2 weeks where as a fistula must dilate or enlarge which can take between 6-12 weeks.  Exercising the access arm can help the fistula develop. You, the patient, should start learning how to care for your access immediately after surgery by following the steps below.

Step 1

It is normal to have some swelling in the surgical incisional area.  To help control this swelling keep your arm elevated (above your heart) starting immediately after surgery and for the next 1-2 weeks or until the swelling is diminished. Wiggle your fingers and clinch your fist 10 times every hour, while awake, for the first 5-7 days. Also, bend and straighten at the elbow to regain normal range of motion. These exercises are designed to promote circulation in the fingers and aid in draining away the excess fluid accumulation in the immediate area. If numbness is present, sensation will return sooner if the exercises are done as prescribed.

Step 2

On post-op day 5, you should begin squeezing a rubber ball. The dialysis unit usually can provide one, if not a tennis ball will work. Squeeze the ball 10 times every hour and hold the squeezed position for 3-5 seconds each time before releasing grip. This helps the vessel wall to strengthen and thicken so it will seal up quickly and won’t leak into the surrounding tissue after the needles are removed. It also dilates or engorges the vessel by trapping blood in it under pressure during the 3-5 second hold phase.
This exercise is crucial in the development or “maturation” of the fistula and may need to be performed for several months.

Step 3

Each day, using your opposite hand, feel over the fistula for the “thrill” or vibration that is normally present. Also bring your access arm up to your ear and you may be able to hear the ‘bruit’ or buzzing-(the rushing ocean sound). If one of these is not present, call the dialysis unit or Dr. Cohn right away for instructions.  Do not wait for your next appointment. This is a sign that your fistula may be shutting down or already has and requires medical attention.

PROTECTING YOUR NEW FISTULA/GRAFT
1. Avoid wearing tight constrictive clothing over that arm.
2. Avoid wearing jewelry that is tight, such as a watch on the access arm.
3. Avoid carrying heavy objects.
4. Avoid purse straps over the fistula.
5. Do not sleep on the arm or keep it bent for extended periods of time. (Elevating your arm on a pillow will help you avoid sleeping on your arm)
6. Keep your access clean at all times.
7. Be careful not to bump or cut your access.
8. Don’t let anyone put a blood pressure cuff on your access arm.
9. Check the pulse in your access everyday!