Hemodialysis patients: protection of native arteriovenous fistula!

Author: Wang Ying, Chief Nurse, Peking University People's Hospital

Reviewer: Mao Yonghui, Chief Physician, Beijing Hospital

For uremic patients undergoing hemodialysis, autologous arteriovenous fistula is the main form of long-term vascular access, and its care is very important. Patients need to be guided in self-care after surgery and during long-term maintenance after the fistula matures.

Nursing and exercise for hemodialysis patients after autologous arteriovenous fistula surgery:

First of all, the limbs may be a little swollen after the operation, so it is recommended that the patient raise the limb on the side with the fistula. For example, when sleeping, you can put a small cotton pillow under your arm. This can reduce the swelling of the limb after the operation and relieve pain.

Secondly, if there is no obvious sign of bleeding or infection 24 hours after the operation, you can start doing some wrist movements, such as gently clenching your fist or moving your wrist joints to promote local blood circulation and reduce the chance of thrombosis.

Two weeks after the operation, the stitches can be removed from the wound. After the stitches are removed, you can use a grip squeeze ball, a gripper, etc. to exercise your arm functions as appropriate. So how should you exercise specifically? For example, you can squeeze a fitness ball with your hands. You don't need to use too much force when squeezing it. Just squeeze it gently to gradually expand the blood vessels and achieve the effect of functional exercise. There is no fixed rule for the frequency of exercise. For example, you can practice several times a day for 1 minute each time.

Figure 1 Original copyright image, no permission to reprint

Things to note for hemodialysis patients after their autologous arteriovenous fistula matures:

First, do not lift or carry heavy objects on the limb on the side of the fistula. In daily life after surgery and long after the fistula matures, you should pay attention to protecting this limb from weight bearing. Lifting or carrying heavy objects after surgery can not only easily cause wound rupture, but may also slow down blood flow on this side of the limb, which can easily increase the risk of thrombosis.

Second, pay attention to changes in blood pressure and prevent the possibility of fistula embolism caused by low blood pressure. For patients on maintenance hemodialysis, blood pressure fluctuations occur from time to time, so they should learn to palpate and auscultate their fistulas to observe changes in blood flow in the access. It is recommended that patients develop a habit of palpation or auscultation at fixed times every morning, after dialysis, after meals, and before bedtime. When low blood pressure occurs, the frequency of palpation and auscultation should be increased. If fistula tremors or murmurs weaken or disappear, medical attention should be sought immediately.

Third, don't wear clothes with tight cuffs, don't wear bracelets, bangles, watches and other accessories on this side. Reduce pressure when sleeping, don't sleep on the side with fistula, this is also something to pay attention to.

Fourth, you should keep warm in winter. Of course, it is not good for your limbs to be too hot or too cold.

Fifth, professional doctors and nurses all know that after the fistula is established, blood pressure measurement, blood drawing, and infusion are not required on the access side. However, patients should also be aware of this to avoid visiting other hospitals or departments where medical staff may not know that you have an arteriovenous fistula, which may increase the risk of injury and thrombosis.

Sixth, for patients, if they feel swelling, pain, redness, or signs of infection at the fistula, including any abnormalities in the pulsation of the blood vessels on the fistula side, they should communicate with doctors and nurses in time for timely treatment.

Seventh, maintain good hygiene habits. You should develop the habit of cleaning the arm on the puncture side before each dialysis. If there is blood stains or sweating at the needle hole after dialysis, the needle hole should be disinfected.

Figure 2 Original copyright image, no permission to reprint

Common complications of native arteriovenous fistula in hemodialysis patients:

First, infection

Pay attention to personal hygiene after surgery, ensure the cleanliness of the limb on the access side, and keep the underwear soft and comfortable. Doctors will generally check the wound dressing to ensure that the dressing is clean and dry, which is very important. It is not recommended to bathe the arm on the access side during the period when the wound has not healed, mainly to avoid infection. If infection symptoms such as redness, swelling, heat and pain occur, antibiotics should be actively used for treatment while monitoring blood bacterial culture, and the type of antibiotics should be adjusted at any time according to the results of drug sensitivity tests, and surgical intervention should be performed if necessary.

Second, blood clots

After the autologous arteriovenous fistula surgery, blood clots are prone to occur in the narrowed blood vessels. Low blood pressure, arm pressure, vascular spasm, hypercoagulable state, etc. are all common causes of blood clots.

Third, bleeding and hematoma

Bleeding and hematoma are related to the trauma risk of the surgery itself, the patient's own coagulation state, and the use of anticoagulant drugs, and require close observation and timely treatment.