A fistula for hemodialysis is a modern technique that is highly effective. To ensure continuous hemodialysis (a method of blood purification), a vascular access is created. Simply put, a fistula is a fistula that allows you to directly connect an artery and vein.

The very essence surgical intervention is that surgeons form an arteriovenous aneurysm that connects a peripheral vein and an artery.

Until recently, chronic renal failure was considered a death sentence with almost one hundred percent. But already now the disease is being treated quite successfully.

What is the procedure for?

A fistula is essential for chronic dialysis. Access to blood circulation is obtained due to vascular access, which allows blood purification.

To put it simply, the vascular access, in fact, creates a kind of hole where a large amount of blood can be injected or extracted.

As a result, the venous walls become much thicker, and the speed of blood movement through the venous vessel is higher. As a result of the fistula placement of the patient with renal failure, it is much easier to connect the artificial kidney machine.

A fistula is a guarantee of a high-quality diagnosis, and with it there are much fewer complications.

Thanks to the fistula, the artery and vein are sutured and a vessel with thick walls and good arterial blood flow is created. This vessel is located superficially, it is convenient to puncture it and it is easy to purify the blood.

During the procedure, a specialist stitches on one hand. The peculiarity of the arteries is that they have good blood flow and deep location, and their puncture is associated with a number of difficulties. Unlike arteries, veins are superficial, accessible and thin, so there will not be enough blood flow for dialysis. That is why combining them is a wonderful solution to the problem.

The vein and artery are sutured on one arm. Although the arteries have good blood flow, they are deep and can be extremely difficult to puncture. On the other hand, the veins, although they are superficially located, are too thin, which will also cause problems, which is why their connection is the right solution that will save the situation.

Features of fistula for hemodialysis

Like any procedure, fistula placement has a number of advantages and disadvantages. First, let's talk about the benefits.

"Pros"

The main features of the procedure are the following factors:

• the fistula is located directly under the skin;
• the fistula is created exclusively from the patient's tissues;
• the risk of infection and thrombosis is reduced to zero;
• the possibility of the system functioning for several years or even decades;
• constant updating of the methods of setting the fistula, which will improve the procedure itself.

Prolonged maturation of the fistula is the main disadvantage of the procedure.

Minuses

There are quite a few disadvantages of the procedure, but you still need to know about them:

• the fistula can mature for one to two months or more;
• the fistula may not mature at all. This happens for a number of reasons: insufficient blood flow to the fistula, low blood pressure in the fistula, a small vessel to create a fistula.

Preparation for the procedure

Before carrying out such an important procedure, it is important to carry out a number of diagnostic studies to assess the patient's condition. Particular attention is paid not only to the state of the cardiovascular system, but also to the functional abilities of the kidneys.

Full and extensive diagnostics should be carried out, which includes:

• ultrasound of blood vessels, kidneys, heart;
• functional diagnostics of the heart;
• renal-hepatic complex;
• angiography;
• x-ray chest;
• general analysis of urine and blood;
• analysis for hepatitis, HIV.

Full diagnostics is the most important stage of preparation

In the course of such a study, specialists determine the state of the protein and electrolyte balance, and if this is necessary, then adjustment should be carried out. In addition, the hemoglobin level should be normal at the time of surgery.

The doctor also needs to inform about the medicines, and if they are capable of causing any problems during the surgical intervention, then they must be canceled. In particular, these drugs include anti-inflammatory drugs, as well as drugs that affect blood thinning.

The essence of the operation

Correct operation and installation of a fistula is the key to a successful and speedy recovery! So, the suturing of the vein and artery occurs in the forearm. Why in this particular area? The point is that this place is convenient for puncturing.

The result is a vessel that has a superficial location with sufficient arterial blood flow and has thick walls. In addition, the established fistula is not susceptible to infectious complications and is capable of acting for a very long time - literally several decades.

The procedure is carried out in several stages, namely:

1. the first thing that is done is anesthesia;
2. the future incision site is processed according to all the rules of asepsis and antiseptics;
3. after exposing the artery, a ligation is done, and then transection;
4. the next step is the mobilization of the lateral vein and further clamping;
5. then there is a dissection of arterial and venous vessels and stitching;
6. the wound is sutured;
7. the final step is the application of a bandage.

How to properly care for a fistula?

When should a patient start caring for a fistula? Much earlier than you think, actually. This must be done even before the surgery.

The photo shows the process of fistula formation

In order to create a fistula, it is necessary that the arteries and veins are well developed, which is why the veins of the forearm must be protected and punctured less.

Dialysis should begin when the fistula is already mature. This is the only way to hope for long-term and high-quality work of the fistula.

In some patients, after just a couple of years, the service life is exhausted, in order to extend this time, it is necessary to adhere to the following recommendations:

• in the postoperative period, especially in early dates, it is necessary to provide the hand with peace, it is better if it is on a hill;
• if we talk about the later stages of the postoperative period, then the fistular arm should not be overly protected, it is useful and necessary to give moderate physical exercise, but in no case should power and heavy loads be given;
• it is necessary to dry the fistula every day;
• listen for the noise coming from the fistula. It should be approximately the same, but if there are any changes, then it is better to consult a doctor;
• do not forget about hygiene measures;
• in no case should you sleep on the fistula arm;
• should be monitored arterial pressure and avoid sudden changes;
• on the fistula arm, you should not measure pressure and take blood for tests.

Checking the condition of the fistula

The check-up should become as familiar to you as brushing your teeth in the morning. You must make sure that the fistula is okay by visual inspection as well as to the touch.

The fistula should be kept in good condition as it plays a key role in the success of dialysis

Any signs of redness or swelling are not the norm, so you should pay attention to this and inform your doctor at the first changes. A stethoscope can help you hear the characteristic murmur and understand how good the blood flow is. You can ask the medical staff how to do this correctly.

Don't be afraid to gently touch the fistula. You should feel a certain vibration - this is the norm. You must be careful, the fistula should not be warmer than usual, and a light touch should not cause any pain.

The following simple rules help to minimize the chances of infection and thrombosis.

Free blood flow should not be impeded

If you squeeze the fistula arm, then there is a high likelihood of thrombosis, especially for people with arterial hypotension.

Follow these tips:

• do not wear tight clothes, as well as squeezing watches and bracelets;
• you should not bend your arm too much.

Compliance with the rules of personal hygiene

Personal hygiene practices include the following:

• the access point must be washed with plain water, but there must be soap specially designated for this procedure. It is necessary to carry out such a cleansing procedure before dialysis;
• the site of the fistula should not be scratched.

Do not cough or sneeze on your fistula arm.

Protection from injury

Running and cycling is the optimal load for the fistula arm. You should not take heavy objects in your hand, it is better to take care of yourself.

Temperature drops are the enemy of fistula

Too high or, conversely, low temperature adversely affects the fistula and can lead to thrombosis. Excessive heat, such as going to a sauna or steam bath, causes the blood vessels to dilate, causing blood pressure to drop. It is logical that the blood flow slows down. Therefore, you should not visit the bathhouse, even in hot weather it is necessary to keep in the shade.

Excessive cold, on the contrary, constricts blood vessels, but also slows down blood flow, so in cold weather you need to dress warmly.

In order to increase the use of fistulas, dialysis centers try to adhere to the following guidelines, namely:

• continuous diagnostics of vascular access;
• timely consultation with a nephrologist;
• a complete surgical assessment of the possibilities of fistula placement and site;
• training of medical personnel to improve their skills in puncturing;
• evaluation of work results.

Survey

Signs and symptoms of infection include:

• hyperemia,
• discharge,
• pus,
• defects.

Cold hands, pallor and cyanosis are clear signs of poor blood flow. Conversely, a hand that is hot to the touch may indicate an infection.

As for the noise that is being heard, it should be distinct and prolonged, and each subsequent sound should be associated with the previous one.

So, fistula in hemodialysis is an innovative technique that has proven to be highly effective. Follow simple guidelines and it will serve you for years to come.

A fistula for a hemodialysis procedure is one of the state-of-the-art techniques with high efficiency. In order to constantly purify the blood in the patient's body, an artificial fistula is created, and in the language of doctors - vascular access. It connects directly the peripheral vein and artery.

Many people are interested in what a fistula is.

Thanks to this method of hemodialysis, renal failure has ceased to be considered a sentence, that is, a diagnosis in which a lethal outcome is inevitable. Now this disease is effectively treated with the installation of a fistula. It is only important to follow the rules and recommendations for caring for it.

Why is a fistula needed?

The fistula is installed for permanent hemodialysis (also called chronic). Thanks to the vascular aneurysm, the blood purifier has access to the human circulatory system. Simply put, it is an opening in the body that lets blood in and out.

As a result of such procedures, the walls of the veins thicken and the blood flow accelerates. Thanks to the fistula of the patient with renal insufficiency, it is very easy to connect to the artificial kidney machine. Doctors recommend this procedure because it increases the possibility of an accurate diagnosis and, therefore, avoids unnecessary complications.

What is a fistula, patients often ask.

An artificial fistula "stitches" a vein and an artery, creating a vessel with thickened walls and arterial blood flow. The vessel is located superficially, which makes it much easier to puncture. And this is very important in hemodialysis.

In an operation to create a fistula, the doctor sutures an artery and vein in one of the patient's arms. Arteries, with good blood flow, are located deeper than veins, therefore arterial punctures are considered to be procedures of increased complexity. Veins are located under the skin, but at the same time they are thin, and such a structure of a blood vessel is not enough for hemodialysis. Fistula placement was a great solution to this problem.

Pros of fistula

The advantages of installing a fistula for hemodialysis include the following points:

Minuses

The operation has fistulas and disadvantages. And here they are:

• it "ripens" for a rather long time - up to two or more months;
• there are cases when an artificial fistula does not "mature" at all. The reasons can be different, from insufficient blood flow to low pressure in the circulatory system at the site of the fistula.

What is, we have explained.

How is the preparation for this procedure going?

First of all, the patient undergoes a series of examinations before creating a fistula. It is important for doctors to know about the state of his cardiovascular system, how the kidneys function. So, ultrasound of blood vessels, heart and kidneys is carried out, liver and kidneys, heart are diagnosed, angiography, chest x-ray are done. Also, the patient must pass tests: OAM, UAC, HIV and hepatitis tests.

The indicators of electrolyte and protein balances are also important for physicians. If they are not normal, then they are corrected. During the operation, the hemoglobin level must be normal. If the patient is taking any medication, he must inform the doctor about it. The action of some drugs can complicate the operation process, in which case they are canceled. These medicines are anti-inflammatory and anticoagulants (or having by-effect blood thinners).

How is a coronary-pulmonary fistula established?

How is the operation going?

Suturing of the vein and artery is done in the forearm, as this is one of the most convenient areas for puncture. As a result of forearm surgery, a superficial vessel is obtained through which arterial blood flow passes. Its important characteristic is its thickened walls.

The patient is first given anesthesia. After its effect takes effect, the surgeon treats the incision site with aseptic and antiseptic drugs. As a result of the incision, an artery is exposed, which is tied up (so that no blood flows), and then dissected.

Then, in a similar way, the lateral vein is extracted, on which clamps are applied, and then dissected. The vein and artery are sutured in a special way and placed under the skin. The doctor sutures the surgical wound and applies a bandage.

A pulmonary fistula in a child also occurs. More on this later.

Fistula care

The fistula needs care. Moreover, the preparation of the body for its creation begins even before the operation. For example, the veins of the forearm, which will be operated on according to the plan, do not undergo punctures and injections. The dialysis procedure is possible only after the fistula has matured, otherwise complications cannot be avoided.

In some cases, as a rule, when the patient did not adhere to the doctor's recommendations, the fistula lasts only a couple of years. What should be done to extend its lifetime?

Coronary-pulmonary fistula in children

It is an abnormal connection between a vein and an artery.

Congenital coronary fistula is often asymptomatic. In a large number of children with this pathology, when listening to the heart, a continuous specific murmur is recorded, especially if the fistula is small or medium in size. In newborns and children younger age the following symptoms can be identified: angina pectoris, tachycardia, sweating, irritability, rapid breathing, pallor.

Infants with coronary fistula are admitted to the hospital at the age of 2-3 months with signs of heart failure. Such children experience fatigue during feeding, often refuse to breast, whistle is heard when breathing, sweating increases, occasionally the child is pale, his height and weight are below normal.

What is a fistula is now clear.

The kidneys are one of the most important organs in the whole excretory system... If their work is disrupted, a person experiences serious pathologies.

In case of development of insufficiency, the patient is prescribed.

During its implementation, a special fistula is used. This article will discuss this design, the features of its installation and use.

general information

("") Is a procedure that is performed to restore kidney function in acute or chronic failure. With such a disease, the organ cannot cope with its functions and toxins accumulate in the body along with urine.

Let's consider the essence of the procedure: with the help of a special preparation, the patient's blood is cleared of toxic substances, the water-electrolyte balance is being established.

If the patient is on continuous dialysis, then a special fistula is installed. This is a kind of "vascular place" from which contaminated blood is removed and returned back in a purified form.

Thanks to this adaptation, the walls of the venous vessels expand significantly and blood circulation through them is accelerated.

Thanks to the use of a fistula, hemodialysis is simplified, since several areas on the artery and vein are stitched together. Based on the anatomical structure, blood moves faster through the arterial vessels, and they are located much deeper than the venous ones.

This is what causes difficulties in time. Doctors have found a unique method of fistula placement that simplifies the blood purification process. It should be noted that the suturing of the vessels is carried out only on one hand.

Indications for use

A hemodialysis fistula is necessary to improve the hemodialysis process. The main indications for use are:

• or kidney failure;
• imbalance of electrolytes in the body;
• swelling;
• severe poisoning with toxic substances or food;
• low glomerular filtration;
• urinary problems.

Arteriovenous fistula and its features

This is a special shunt that is placed between an artery and a vein. Thus, the walls of blood vessels are sealed and the process of cleansing the blood from toxins is accelerated.

It is located under the skin, does not undergo the formation of blood clots, and a puncture needle is easily inserted into it.

There are several types of arteriovenous fistula: radiocephalic, brachiocephalic, brachiobasilar. Depending on the diameter of the vessel used, a distinction is made between radial and brachial fistula.

It should be noted that such a device with proper care has been functioning for many years.

However, even this procedure has its advantages and disadvantages. Among the advantages are:

• the device is created exclusively from human vessels, no foreign materials are used;
• is clearly under the skin;
• infection and blood clots are excluded;
• with proper care, it can be used for up to 10 years;
• scientists are constantly improving this device.

The disadvantages include:

• maturation of the fistula stretches up to 60 days;
• there is a risk that the device will not mature due to a number of negative factors: poor circulatory pressure, a small area of ​​the operated vessels, etc.

In addition to this type of device, an artificial prosthesis or catheter can be installed for a patient for hemodialysis. They are much inferior in functionality to AVFs, therefore they are not often used.

Preparation for the procedure

The fistula is installed in an operative way. Before that, it is imperative to undergo a diagnosis of the cardiovascular system and establish the usefulness of the kidneys.

Examination and analyzes

Among the diagnostic procedures are:

• Ultrasound of the organs of the cardiovascular system and kidneys;
• assessment of the work of the heart;
• complex of hepatic-renal tests;
• angiographic examination of the circulatory system;
• fluorography;
• blood and urine tests (general, biochemical parameters, hepatitis, HIV).

Be sure to inform your doctor about taking anti-inflammatory or blood-thinning drugs, as they can affect the course of the surgical operation.

Stages of passage

The installation procedure is simple, with sufficient experience of the doctor, it takes no more than an hour. Local anesthesia is used, the shunt is installed mainly on one hand.

In rare cases, when there are not enough blood vessels in a person, the doctor can use special medical catheters or tubes, they replace certain parts of the vein. It takes an average of 30 to 60 days for the fistula to swell, during this period it is strictly forbidden to pierce or injure it.

The essence of the operation is to carry out the following manipulations:

• introduction of local anesthesia into the patient's arm;
• processing of the incision site;
• then the doctor makes an incision in the skin and ligates the necessary artery, then performs its intersection;
• at the next stage, a lateral venous vessel is removed and a clamp is applied to it;
• then these two vessels are dissected and stitched together;
• in the last step, the doctor heals the incision in the arm and applies a sterile surgical dressing.

During the operation, the patient does not feel pain; in the future, proper care of this device is very important.

How to care for a fistula

To obtain a perfect fistula, it is necessary to take good care of the venous vessels and not to expose them to frequent puncturing. There are certain requirements for the care of this device.

Checking the status

During the postoperative period, it is necessary to keep the operated arm in strict rest, it is forbidden to lift heavy things or sleep on this side.

Personal hygiene

An important condition is adherence to the rules of personal hygiene.

It is necessary to monitor the cleanliness of the hand on which the fistula is installed, periodically treat it with disinfectant solutions.

Protection from injury

It is necessary to protect this device from injury, as they will provoke severe subcutaneous bleeding. Under no circumstances should you measure blood pressure or give injections on the operated arm.

Free blood flow

When squeezing a hand with an installed fistula, the risk of blood clots increases, so you need to wear loose clothing, avoid wearing bracelets, watches or other similar jewelry. It is not recommended to bend the arm too much at the elbow.

Maintaining normal temperature

Severe temperature changes increase the risk of blood clots, especially in patients with hypertension. Do not abuse baths, saunas or hot baths. These procedures lead to the expansion of blood vessels, as a result of which the pressure drops sharply and the outflow of blood decreases.

In the cold season, the walls of blood vessels narrow, and the outflow of blood becomes weaker. In winter, it is recommended to wear warm clothes to avoid hypothermia.

Complications and prognosis

If used incorrectly, the patient may face the following complications:

• infection;
• poor blood flow;
• the development of chronic heart failure;
• blood clots;
• ischemic strokes;
• aneurysm at the site of the fistula.

When the first unpleasant signs appear, you should immediately contact the institution where the operation was performed.

In the absence of concomitant complications, the installation of the AVF is positive. This also applies to its timely removal.

Conclusion and useful information

To extend the service life, you need to properly care for this structure, carefully handle it after each dialysis session, and in case of the slightest violations, consult a doctor.

It is imperative to avoid the development of an infectious process. The first alarming symptoms are: purulent discharge, skin redness, external defects. In this case, it is recommended to immediately consult a doctor who will correct the fistula.

A fistula for hemodialysis today is a unique way to improve the processes of cleaning the blood from toxic substances. It has a number of advantages, with proper care and installation, it can last up to 10 years.

It is very important to do this procedure only in a good medical center with experienced specialists, this will significantly reduce the risk of complications.

I am 26 years old, on April 30th I will have a fistula installation with a further transition to hemodialysis. This whole situation changed my life completely. The meaning of further life was lost, I had to quit my job. I don’t know how to continue to exist, I feel like a full tree .. I don’t want to live at all, what should I do ??? Something inside is holding back, but all sorts of nasty thoughts come into my head. Help as much as you can, not wanting to lay hands on yourself ...
I really ask for help ...
Support the site:

sdk_devil, age: 03/23/2009

Feedback:

Sdk_devil, I really empathize with your grief. Hold on, brother, just don't give in to despair. Each person must courageously walk his earthly path to the end, endure all the trials. And the fact that something is holding you back is the best confirmation of this. This is said by the part of you that knows for sure that it will live forever, that there is a God who loves each of us and wants us to be saved for eternal life. You may argue how He loves you if He sent such a test. But we cannot know what is necessary for our salvation, but He does. Therefore, rely on the will of God and trust in Him, ask for strength to endure everything.
Read these materials on the meaning of suffering:
And one more thing: come to our forum, we have a lot of kind, sympathetic people, we will pray together for your spiritual and physical strengthening. And when you are on the forum, look at this topic.
Hold on, brother! Strengthen you, Lord!

Alla, age: 39 / 03/23/2009

Hello dear! I read your letter and my heart sank! I saw enough of the suffering and I myself am not a cucumber either! Old grandmother 56 years old with a crooked hand - I practically do not go out into the street only with a stick in the summer - deforming ostearthrosis of all joints and so a bunch of wow list. My dear boy, so I call my son, I called you and I was imbued with your problem! Your sores are not sickly, but you are not crap! I know how hard it is for you and it hurts, but I also know something else - people who have not crawled out of hospitals for years, even arranged a personal life! GOD I won't tell you, you yourself can read about it, find out! Hold on, guy, and throw away the thoughts about the worthlessness of existence as unnecessary! You are one of the strong, I immediately understood this old! I will not read morals, you absolutely do not need them, only I will say one thing - such thoughts are not only visiting you, this is how life is arranged - read what the woman writes about unhappy love-me the old one has disappeared! Write, maybe you need something from TV books or something else - if you bring me in Moscow - that's what I don't have enough money - and I would have taken it to Germany for treatment! Know and remember you are not alone, even in the department where you are lying or lying is also not the only one! I am writing and crying dear, so I would have pressed my smart head and said, people live everywhere! And-you would understand everything dear and not torture yourself! Youth is youth and will pass what you are about worried! I'm not worried that you will enter into a correspondence with the young ones who have their own interests, but know grandma Valka thinks about you and pray! It will not thaw a little bit, I will not be slippery, I will order you in the temple of the magpie for health! Live son you need not only your parents but also me and many more!

Manso, age: 56/23/2009

We are grown-ups, but if we met, I would be ashamed to look you in the eye. Advice is useless, unless: try to find people who are optimistic who continue to live after switching to hemodialysis. They will best understand and support.

And I just sympathize. I really sympathize. And I pray the Lord for you. May a miracle happen and your life will be for the best of possible scenario... Hold on!

Lyalya, age: 26 / 24.03.2009

Hey!
I am a young doctor, last year I spent several months in the department of kidney transplantation in the Oblast. hospital in Novosibirsk. I can tell you that in our city about 60 kidney transplants were successfully performed that year (I talked with many such successful people), one woman then gave birth to a healthy daughter.
So your life is just beginning.
You will wait for your transplant and live the normal life of a healthy person, do not lose faith, you are not the only one :)

Katya, age: 24/03/2009

Native sdk_devil. I got on hemodialysis at the age of 29, in 2006. Was, like you, in a state of shock. Before hemodialysis, I was "lucky" to move from one attending physician to another, they did nothing, they just waited for what? - probably, self-healing (!). With their inactivity for 4 months, they brought me to dialysis. God is their judge.
A void formed around me - friends did not come, relatives were also waiting for an invitation. And so I wanted someone to come by himself, without an invitation, just to support in this life. I didn't know what to rely on, what to live on. The only thing I firmly knew was that it was too early to die.
This is how my daily struggle for life began. I felt like Baron Münghausen pulling himself out of the swamp by his hair. Unfortunately, in our country patients on hemodialysis must not only be treated, but also fight for the right to treatment. Analyzes, medications, trips to dialysis, water treatment, apparatus - on everything, officials from medicine are trying to save money. You need to learn at least a little to understand the procedure and analyzes, do not rely on doctors. They are not responsible for your state of health, if something - the diagnosis of chronic renal failure will write off everything - and their inactivity, and elementary illiteracy and incompetence.
It saves gratitude to God, to people who still support you, and work to the best of your ability. And, most importantly, do not blame yourself for anything. You are not to blame for the illness. Animals also suffer from chronic renal failure, because you will not think that they are to blame for their illness. Only they don't do dialysis, but people are lucky.
Calmly move away from people who do not need you, love and take care of those who supported you. Thank God for every day you feel healthy and active. And ask God not to leave you in the days of ill health.
AND LIVE! Life is beautiful and short. Only now it will not be the same for you as for all other people. You have your own, unusual path, on which now everything depends only on you.
I wish you, dear sdk_devil, stable health and long, happy years of life.

Malika, age: 37 / 08/16/2013

I am 62 for ten years living with a transplanted kidney !!! I feel a normal person!! No need to be afraid of hemodialysis !!! The main thing in this life is diet and less liquid to drink before dialysis !!! It will pass for you !!! You can live with dialysis, but I recommend you get in line for a kidney transplant !! The queue is how lucky you are with the compatibility of the tests, you can get a donor kidney in a month or maybe in a year !!! So do not despair in 2004 during dialez patients told me all sorts of pride about the transplant !!! But I did it and I have nothing to regret !!! Don't let your legs go forward !! Life is good!!!

Kolya, age: 63 / 08/15/2014

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