Why? When? And How? Let's discuss the importance of a fistula

Please consider this YouTube Video to learn more about fistula or graft placement:

As patients approach the need for kidney replacement therapy, the importance of proper preparation becomes critical. Denial is not going to prevent the inevitable. If the time has come, and you are going to need dialysis, then the time has come.

If you want to avoid emergencies, the hospital, and infection related to needing a large catheter in the neck (or said another way, a large intravenous line in the jugular), consider a fistula as the preferred alternative in the later stages of CKD stage 4 or early stage 5.

Sometimes a video can be instructive to help explain the process. The above video will help do just that. Please consider watching.

To summarize: in order to go forward with the kidney dialysis procedure, almost a pint (or 0.5 liters using the metric system), passes through the kidney dialysis machine every minute.

We need to perform in 4 hours, 3 times a week, the same work the kidneys perform over the 24 hour, 7 day week. The normal anatomy of the body is unable to do this, so we construct a fistula to facilitate. The kidney doctor doesn’t perform the procedure, instead the kidney provider consults a vascular surgeon who does it.

Once constructed, or made, the fistula (an artery which is connected to a vein in the arm) allows the placement of needles for the dialysis procedure.

Here is an example of a left brachiocephalic AV or arteriovenous fistula.

Left Brachiocephalic AV Fistula. The blood flows from the artery in red to the vein in blue.

Note: the surgeon usually places the fistula in your non-dominant arm so you can write and move your dominant arm during the dialysis procedure.

So, if you are right handed, the surgeon tries to place the fistula in your left arm. Also, don’t worry about all the fancy terminology. Just note that a fistula means we are using your own vessels for dialysis, and a graft means we are using a plastic conduit to facilitate the connection between the artery and the vein for dialysis.

There are different places a fistula can be placed, usually in the forearm or the wrist. The vascular surgeon will determine the best placement.

Sometimes 2 procedures will be necessary in order for the fistula to work. The surgeon may place the fistula and then wait for it to mature. Then when ready, the surgeon will superficialize the fistula, bringing it up to the surface so that the dialysis nurse can access it. Two surgeries are not always required.

There are many variations to this. The key here is time. You want to be able to do this correctly. That’s why getting to the surgeon early is preferred.

If I am not making sense or the provider in the video is not, consider reading this blog post a few times and watching the video a few times to gain better understanding.