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Internal arteriovenous fistula
Description
- A permanent access of choice for the client with CRF requiring dialysis
- The fistula is created surgically by anastomosis of a large artery and large vein in the arm.
- The flow of arterial blood into the venous system causes the vein to become engorged (matured or developed).
- Maturity takes about 4 to 6 weeks, depending on the client’s ability to do hand-flexing exercises such as ball squeezing, which help the fistula mature.
- The fistula is required to be mature before it can be used because the engorged vein is punctured with a large-bore needle for the dialysis procedure.
- Subclavian or femoral catheters, peritoneal dialysis, or an external arteriovenous shunt can be used for dialysis while the fistula is maturing or developing.
Advantages
- Because the fistula is internal, the risk of clotting and bleeding is low.
- The fistula can be used indefinitely.
- Fistulas have a decreased incidence of infection because it is internal and is not exposed.
- Once healing has occurred, no external dressing is required.
- The fistula allows freedom of movement.
Disadvantages
- The fistula cannot be used immediately after insertion so planning ahead for an alternate access for dialysis is important.
- Needle insertions through the skin and tissues to the fistula are required for dialysis.
- Infiltration of the needles during dialysis can occur and cause hematomas.
- An aneurysm can form in the fistula.
- Congestive heart failure can occur from the increased blood flow in the venous system.
