What are tips to get longevity out of a fistula? My Rn rotates the sites but my fistula hasn't developed higher up where the venus needles go yet (4 mo. old). Is it ok to sleep lightly against the fistula arm?

Linda,

Four months old is still a fairly new fistula, so just keep the site rotation going. As the fistula is used and matures, more venous areas should develop.

Would you like to learn how to cannulate your own fistula? If so, the buttonhole technique might be a good option. You can get more information on the buttonhole technique under the old post for buttonhole.

Sleeping on a vascular access is thought to cause clotting of the access. The idea is any thing that causes a low flow within the vascular access, can lead to clot formation at the arterial inflow of the vascular access. Low blood pressure, excessive pressure (watch, purse, heavy items or direct pressure with post dialysis needle holding), poor heart function or sleeping on the extremity can all cause a transient decrease in the blood flow within the vascular access. The vascular access can then form a clot at the arterial anastomosis, which causes the vascular access to be thrombosed (clotted). A vascular access that already has a low blood flow or a stenosis (narrowing) is at a higher risk to thrombose (clot) if any transient event occurs that lowers the blood flow even more. So if you sleep lightly on your fistula it may or may not clot. Fistulas can tolerate a much lower access blood flow and still not clot. But to be safe, it is best not to sleep on your fistula. Your fistula is your �lifeline�.

A patient with a graft is at a higher risk for the graft to clot from sleeping on the graft arm. Grafts need a higher access blood flow to stay patent (open). Grafts also can develop stenosis (narrowing) more often than a fistula. This narrowing at the venous anastomosis or outflow vein can cause a decrease in the access blood flow. Grafts with an access blood flow less than 600ml/min has a higher risk of clotting than a graft with an access blood flow greater than 600 ml/min. (NKF DOQI Guideline 10). To learn more about this topic, see the Topic page for Patient Education.

Hope I answered your question. Please post any additional questions. As always, talk with your dialysis personal about your specific vascular access.

Deborah Brouwer