Operation Purpose

Vascular access for long-term hemodialysis when kidney function is poor.

Preparation before Surgery

• Sign the informed consent for surgery and anesthesia.
• Avoid any treatment (e.g. injection, blood drawing, intravenous drip) of a limb that planned for operation.
• In principle, local anesthesia is performed, which does not require fasting.
• General anesthesia or plexus anesthesia require fasting for more than 8 hours. Before operation blood, electrocardiogram and chest X-ray examinations need to be checked.
• Remove items (watches, bracelets, rings, removable dentures, nail polish, etc.) from your body before surgery.
• Change into a patient gown.

Surgical Procedure

• Time of operation
  • Natural blood vessels: about 40 to 60 minutes.
  • Artificial blood vessels: about 20 to 90 minutes.
• A feeling of mild electrical stimulation under local anesthesia.

Notes after Surgery (Natural Blood Vessels)

• The surgical wound may bleed slightly. Do not overapply pressure. If the whole gauze is wet, seek medical treatment at the hospital as soon as possible.
• Sometimes the thumb and forefinger feel numb or throbbing. Don’t be alarmed as it recovers slowly.
• Under normal conditions, limb swelling should be minimal.
• After 2 to 3 days, you can start to grip a soft ball. Hold the ball tightly for 5 seconds and then relax. Hold the ball 100 times a day and increase it gradually.
• Blood vessels can be used about 4-8 weeks after surgery (depending on the individual situation).

Notes after Surgery (Artificial Blood Vessels)

• There will be obvious swelling and pain in limbs after operation, which can be relieved by
  • Ice compress: within 72 hours after operation.
  • Postural drainage: try to keep the affected limb higher than the heart(lifted high at ordinary times while propped up at bedtime)
  • Medication: painkillers relieve discomfort.
• The swelling may last for 2 weeks and gradually subside.
• Starting hand exercise 72 hours later can reduce the swelling and need to last for 6 months.
• Don’t puncture for hemodialysis until swelling subsided (about 4 weeks).

Principles of Long-term Care of Fistulas

• It is forbidden to perform any treatment other than dialysis, such as measuring blood pressure and drawing blood.
• Avoid postures or behaviors that compress fistulas (bent elbows, heavy lifting, lateral lying on fistula side, etc.).
• Pay attention to the patency of the fistula regularly: after hemostasis by compression, before going to bed, and after getting up.
• Early detection, early treatment (insufficient flow, high venous pressure, poor vasodilation).
• Regular outpatient exams in the department of cardiovascular surgery.
• If the shunting flow of fistulas stopped, seek for treatment from the cardiovascular surgeon immediately.