This leaflet explains what to do after you have had your fistula formed and possible complications.
I’ve had my fistula formed – what happens next?
After a period of monitoring in hospital, you will be allowed to go home. You are likely to be some pain after the operation, so paracetamol can be taken if needed. If you also have a dialysis line, please do not take paracetamol regularly. Use it only if it is needed. There may be some stitches in the skin and a dressing over the operation site. The dressing needs to stay on for the first 48 hours. Please keep the dressing clean and dry. After 48 hours, the dressing can be removed carefully at home.
Prior to discharge we will show you how to check the fistula is healthy. This can be checked in two ways:
- Feeling for a ‘thrill’ e.g. the fistula should buzz under the skin when you feel it.
- Listening for a ‘bruit’ (brew-e) e.g. whooshing sound the fistula makes due to blood flowing through it.
This should be checked every 4-6 hours for the first 48 hours after the operation.
Other things to do after your operation include:
- Keeping your arm elevated on at least 2 pillows until the swelling has reduced.
- Keeping your fistula dressing clean and dry to prevent infection.
- Keeping your arm and hand warm to encourage blood flow.
- Avoiding any pressure on your arm or wrist as this may cause the thrill (buzz) to stop or a clot to form inside the fistula. This includes:
a) Tight clothing
b) Wrist watches/ jewellery
c) Sleeping on your arm - Avoid any heavy lifting to allow healing to take place.
We will also provide you with a fistula armband to wear. This will help people know that you have a fistula in place and that they aren’t allowed to do blood pressures or blood tests from that arm.
Fistula exercises and checks
Once your stitches have been removed (if there were any) and the wound has healed (around 2 weeks), you can start doing fistula exercises. These exercises make the fistula bigger and stronger. This will make it easier to insert the needle(s) for dialysis.
Exercises include:
- Opening and closing your hand squeezing a soft ball.
- This should be for no more than 2 minutes.
- Repeat this four times a day.
Your fistula should be checked daily for a thrill (the buzz when you feel it.) If this isn’t present, please contact the paediatric dialysis unit/Ward L50 urgently.
When can my fistula be used?
It usually takes 6-8 weeks for a fistula to grow and be strong enough to use for dialysis. However, it can take longer and sometimes a second operation is needed before the fistula can be used. If you have a central venous catheter (CVC) for dialysis, this will be removed once we know the fistula is working well.
It is normal to be worried about having your fistula needled for the first time. We can use numbing cream over the fistula or cold spray so that it hurts less when the needle is inserted. We can also ask your play team to support you if you think this might be helpful.
Maintaining skin health
To keep the skin over your fistula nice and healthy, we recommend that you apply a simple, non-perfumed moisturiser over the fistula once a day after it has fully healed.
Possible Complications
| Complication | Explanation |
| Bruising or swelling of the fistula | This often happens with a new fistula and is due to the dialysis needle going into the fistula |
| Your fistula is red or hot to touch | This could be a sign of infection so please check your temperature |
| The fistula becomes very swollen (Aneurysm) | This is a swollen area that can occur over time due to the needles being put in the same area. Signs of this include: – Thin and shiny skin – A visible pulse under the skin. – A sudden swollen area |
| Cold hand and/or pale fingers or hand (Steal Syndrome) | This occurs because your hand is not receiving enough blood. When a fistula is made, some of the blood that would normally go to your hand is being diverted or “stolen” by the fistula. Signs of this include: pain, coldness or tingling in the fingers/ hand of your fistula arm |
| Bleeding | If this happens urgent pressure should be applied. The bleeding should stop quickly. Please see below for what to do if large bleed occurs at home |
Inform the dialysis unit immediately if concerned about any of the above.
Large bleed from a fistula
This is a Medical Emergency
- Apply firm pressure at the bleeding point for 5 minutes before checking to see if it has stopped. Use a small gauze square/ two fingers/bottle top (supplied in safety pack) to apply pressure. Do not use a large dressing or towel as it may stop you applying enough pressure in the right place.
- Get help from anyone who is around, the blood flow can be fast and make you feel faint.
- Lie down.
- Lift the bleeding arm up and ask someone to help by supporting your arm over your head.
- If still bleeding after 5 minutes, double check you are pressing in the right place.
- If bleeding heavily call 999 immediately and report “excessive bleeding from fistula”, or if it is a slow bleed and you cannot get it to stop call 999 after 30 minutes.
- A large bleed can be very scary. Try your best to stay calm.
Further information
Contact us
If you have any further questions, please discuss these with your doctor in clinic or contact the team on one of the numbers below:
Leeds Paediatric Dialysis Unit
Available Monday – Friday 07.30-18.00 and Saturday 07.30-12.30.
Ward L50 (Paediatric Kidney Ward)
Available 24 hours a day