What does a Healthy Dialysis Fistula Look Like?

Mattie P saw the pic of my fistula and asked: Is your fistula considered healthy?

It is. However, you often can’t tell by looking. There are several ways to tell:

• It has a strong ‘thrill” (a whooshing noise and a buzz in time with your heart beat, where the vein is joined to the artery). This indicates lots of blood flow, which is what is needed if the arterial needle is to get enough blood to push through the machine.
• If you keep your arm straight and raise your hand above your head, the blood should drain from your fistula, and leave it looking like a deflated balloon (see video below). This is also good, because it shows that your fistula is not clotted or blocked and that the blood is coming from and going to the rest of your body.

• When you lower your arm, your fistula fills up again, quick smart. Good for the same reason as above.
• When you gently press on the fistula, it is painless, soft and resilient, again indicating good blood flow.

Eventually your fistula will get hardy and tough (and ugly, but that’s what shirt sleeves are for). All things are relative. Young fistulas are soft and can be fragile. As they get used, the fistula (vein) wall gets covered in scar tissue, which acts to protect it a little from the constant needling. Hopefully you experience fewer and fewer blow outs from over-enthusiastic needling or from an inadvertent arm fold or bend that blocks the return (venous) blood flow.

Two things you don’t need in your fistula: blockage or clotting and infection.

Blocking or clotting directly impairs the efficiency of the dialysis (since less blood is being cleaned) and thus seriously endangers you health. You can tell if there is a problem by looking for the above healthy symptoms: strong thrill, quick emptying and filling, soft and resilient (no unexplained lumps). If you have a problem, tell your primary nurse and or doctor ASAP. The usual remedy is to have a small operation to have the blockage cleared.

Infection is really bad news. The first signs of an infection may be redness, leakage and pain, skin wearing away resulting in exposure of the fistula wall or a combination. It does not impair the blood flow, but it can spread throughout the body and cause sepsis (a toxic condition resulting from the spread of bacteria from the fistula), and even death. Unless caught early, infection can certainly lead to a loss of the fistula. This means a Permacath and all the pleasures that come with it, a stay in hospital to treat the infection and to create another fistula or graft.

Infection is most common in new fistulas, for a couple of reasons: because you are new to the whole process and can make mistakes with infection control; and because you often spend more time in hospital, where infections are more common. Prevention is the key. Always wash your hands and fistula before start dialysis, always use alcohol or other antiseptic swabs before any needling. Wear a glove when you help to remove the needles at the end of the run. If you dialyse at a unit, follow scrupulously the unit’s infection control procedures.  If at home, set up and follow you own procedures.

Anna Catteral once said to me when I had just begun the BigD, and I will never forget it: “Your fistula is your lifeline, look after it.” It is, and I do.

Afternote: The arm lift test shows that the blood flow from the fistula to your body is in good condition.  It does not show how well blood is flowing into your arm, via the anastomosis (where the vein and the artery are joined).   See here for more info.