Advice from American experts. Kidney problems? Fistula

Modern medicine does not stand still, and every year scientists are developing the possibilities of creating a full life for a person with almost any disease.

The essence of the technique

Just a few years ago, kidney failure was considered a fatal disease that could not be cured. Today this diagnosis no longer sounds hopeless. Modern medicine cures this terrible disease with the help of hemodialysis, or blood purification. This method is used for chronic and acute pathologies. A special device, the so-called “artificial kidney,” helps in this process. It helps the body eliminate toxins such as urea and creatine.

In this process it is impossible to do without a fistula. A fistula is a vascular access created by the hands of a surgeon. Most often it forms on the patient’s arm. It is called an arteriovenous fistula. It is connected using needles and special tubes. This method allows a person to partially replace kidney function and he can maintain his usual lifestyle.

Dialysis creates a place for blood to be infused as well as to be removed. Blood volumes can be large. To create such a device, surgeons sew together arteries and veins. This creates a vessel with thick walls and good blood flow. The creation of a fistula does not require the use of artificial materials; it is created directly from human tissue. This is very important as it avoids infection and blood clots. The fistula itself is located directly under the patient's skin. This is the method that patients prefer during treatment. This is the safest and most effective access to the bloodstream.

Underwater rocks

Fistula also has negative properties. These include its long maturation. It takes at least 1 month to form, and sometimes it doesn’t form at all. This may occur due to its poor blood supply, as well as when the lateral veins depart from the fistula with a decrease in blood pressure. The vessel in which the fistula forms may be too narrow, or a narrowing may form between the entrance to the fistula and the junction of the veins and arteries.
To save a fistula, it is necessary to limit the number of injections administered into the arm on which it is formed before the process of its formation begins.

Hemodialysis should be carried out on a mature fistula, this is how it can function for a long time, up to 10 years.

When the fistula matures, it is necessary to protect the hand from excessive physical exertion. The area where it is formed must not be pinched. During this period, blood for analysis is taken from the other arm.

The patient should constantly monitor blood pressure, as it should not drop sharply. Doctors recommend listening to the sound of the forming fistula; it must be even. If the patient feels a change in it, you should immediately consult your doctor.

Hemodialysis fistula can cause some serious health problems. After all, the volume of blood flows through the fistula to the pulmonary artery, which under some circumstances can create an oxygen deficiency in the heart muscle.

The method of hemodialysis and fistula formation is important for modern medicine. How many millions of lives have been saved for seemingly hopeless patients thanks to the research of scientists. Today, the diagnosis of kidney failure no longer sounds like a death sentence, because it can be dealt with using a simple procedure. It will help not only restore kidney function, but also allow the patient to feel like a full-fledged person.

If the kidney is the second heart of a person (this organ performs so many functions), then for a patient on hemodialysis this role is to some extent performed by a fistula. The word, unfamiliar to most people, means “vascular access” - the place from which a significant amount of blood is taken for purification in the “artificial kidney” machine and where it is returned in a form purified from toxins. Usually this is the hand, forearm, although if absolutely necessary there may be other human organs.

So, the normal functioning of the body involves the flow of blood from the heart through the arteries into the capillaries, then the movement occurs back through the veins. An arteriovenous fistula is an artificially created anastomosis of an artery and a vein; they are “stitched” - as a result, the blood moves along the communication between the vein and the artery, bypassing the capillary network. Naturally, the blood flow increases, the vein swells - which makes it possible to quickly pump blood through special needles.

— Is it possible to do without surgery?

The operation to form a fistula is considered simple, if the vessels are sufficiently developed and there are no concomitant diseases, then it will last about 40 minutes. In this case, the patient remains fully conscious, the operation is performed under local anesthesia.

If the natural formation of a fistula is impossible for some reason, then special vascular prostheses are used - tubes that replace part of the vein. They can be punctured within 24 hours after surgery. A fistula formed “naturally” must be protected. It is not recommended to inject it for at least a month. The fistula should “mature” and swell with blood. Otherwise, the artificially created anastomosis of the artery and vein may be disrupted, and the fistula will “stop.”

Watch a video about the operation to create an arteriovenous fistula for hemodialysis (if you can hardly stand the sight of blood and “naked” internal organs, it’s better not to watch):

— Prepare for dialysis in advance

Considering the importance of a fistula for the entire future life of a dialysis patient, experts recommend forming a fistula in advance, as planned, several months before the start of dialysis. This guarantees long-term operation of the fistula and the absence of additional problems during hemodialysis.

True, most patients end up on dialysis too late - when the body is already poisoned with toxins due to poorly functioning kidneys and when the count is already weeks, or even days. Therefore, they have to urgently provide temporary vascular access - through catheters in the central veins - subclavian or jugular, located in the neck and carrying blood away from the neck and head.

- Why is she making so much noise?

A newcomer with a newly formed fistula is quite easy to recognize - as a rule, the patient “listens” to it every now and then. To do this, simply press the operated hand to your ear. This pulsating, slightly whistling sound is difficult to confuse with something else. To some people it resembles the noise of working presses or machines. This pumps blood through swollen veins. The noise should be rhythmic and always the same. If there is any change in sound, you must immediately show your doctor. And if suddenly the noise disappears, urgently go to the dialysis center - the fistula could stop, thrombose. Sometimes blood clots can be removed surgically or with medication.

A fistula sounds something like this:

— From the history of the creation of fistula

It’s not for nothing that they say that everything ingenious is simple. Despite its apparent simplicity, the idea of creating an arteriovenous fistula did not immediately make its way among other scientific inventions. In the first years of dialysis, scientists had to struggle a lot with this problem. At first, a cannula was used as a vascular access - a tube that was surgically fixed and “grafted” to the patient’s vessels.

The beginning of the era of chronic hemodialysis is considered to be 1960, when Belding Scribner and Wayne Quinton from the American city of Chicago managed to solve the problem of long-term vascular access. In them, long-term vascular access was provided by implanting two thin-walled Teflon tubes into the radial artery and saphenous vein. The outer ends of the shunt were connected by a curved Teflon tube, which was removed during hemodialysis, and a hemodialyzer was connected to the shunts.

The next big step was the development of an operation (1970) to form an arteriovenous fistula (nephrologists Cimino and Brescia - authorship is disputed), which is still considered the most reliable type of vascular access.

In our country, the first hemodialysis for a patient with chronic renal failure was performed on March 4, 1958 by A. Pytel and N. Lopatkin in the urological clinic of the 2nd Moscow Medical Institute using an “artificial kidney” apparatus.

— Several rules for caring for a fistula:

— Check its functioning regularly; the noise of the fistula should be pulsating and uniform.

— Take maximum care of the hand with the fistula. Try not to lift weights with it. Do not engage in strength sports - martial arts, exercises with weights, push-ups. Although reasonable loads are needed. At the time of “ripening” of the fistula, doctors even recommend exercises with a manual expander (in the form of a regular rubber ring).

- Do not sleep or lie on the arm with the fistula.

— Eliminate watches, bracelets and other jewelry, clothing that compresses the arm on which hemodialysis access is installed.

— Do not measure blood pressure on an arm with a fistula. It is better to perform all punctures and injections on the other hand.

— The hemodialysis access area must be kept clean, excluding lotions, creams and other perfumes.

— Particular importance of cleanliness on the day of dialysis. Before the session, it is recommended to wash your hand with warm water and soap.

- Monitor blood pressure. Strong jumps in blood pressure do not have the best effect on the condition of the fistula. Do not gain weight too quickly during the interdialysis period.

- Any bleeding is a cause for concern. If after a hemodialysis session the bleeding does not stop for a long time, be sure to consult a doctor.

An educational video (USA) talks about the formation of an arteriovenous fistula. If you carefully read the text above, the film will be understandable without words.

A translation into Russian of the following remarkable work was published in March 2010 by a well-known hemodialysis specialist, author of several books, Doctor of Medical Sciences Evgeniy Aleksandrovich Stetsyuk (website “Hemodialysis for Specialists”, www.hd13.ru). However, the work has not lost its relevance to this day. It is written for medical practitioners, but the language will also be understandable for patients ().

And also read about dialysis on our website:

what it is? Description, advantages and disadvantages. Pulmonary fistula

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Using a fistula for hemodialysis: care and useful tips

The kidneys are one of the most important organs of the entire excretory system. If their work is disrupted, a person develops serious pathologies.

If deficiency develops, the patient is prescribed a hemodialysis procedure.

During this procedure, a special fistula is used. This article will discuss this design, the features of its installation and application.

general information

Hemodialysis (“artificial kidney machine”) is a procedure that is performed to restore kidney function in cases of acute or chronic failure. With this disease, the organ cannot cope with its functions and toxins accumulate in the body along with urine.

Let's consider the essence of the hemodialysis procedure: with the help of a special drug, the patient's blood is cleared of toxic substances, and the water-electrolyte balance is adjusted.

If the patient is on constant dialysis, then a special fistula is installed. This is a kind of “vascular place” from which contaminated blood is removed and returned back in a purified form.

Thanks to this device, the walls of the venous vessels expand significantly and blood circulation through them accelerates.

Thanks to the use of a fistula, hemodialysis is simplified, since several sections of the artery and vein are sutured together. Based on the anatomical structure, blood moves faster through arterial vessels, and they are located much deeper than venous ones.

This is what causes difficulties when taking a puncture. Doctors have found a unique method of installing a fistula, which simplifies the process of blood purification. It is worth noting that suturing of blood vessels is carried out only on one arm.

Indications for use

Hemodialysis fistula is necessary to improve the hemodialysis process. The main indications for use are:

acute or chronic kidney failure;
imbalance of electrolytes in the body;
swelling;
severe poisoning with toxic substances or food products;
low glomerular filtration;
uremia;
urinary problems.

Arteriovenous fistula and its features

This is a special shunt that is installed between an artery and a vein. Thus, the walls of blood vessels are sealed and the process of cleansing the blood of toxins is accelerated.

It is located under the skin, is not subject to the formation of blood clots, and a puncture needle is easily inserted into it.

There are several types of arteriovenous fistula: radiocephalic, brachiocephalic, brachiobasilar. Depending on the diameter of the vessel used, radial and brachial fistula are distinguished.

It is worth noting that such a device, with proper care, functions for many years.

However, even this procedure has its advantages and disadvantages. Among the advantages are:

the device is created exclusively from human vessels, no foreign materials are used;
is located clearly under the skin;
infection and blood clot formation are excluded;
with proper care can be used for up to 10 years;
Scientists are constantly improving this device.

Disadvantages include:

the maturation of the fistula lasts up to 60 days;
there is a risk that the device will not mature due to a number of negative factors: poor circulatory pressure, a small area of the operated vessels, etc.

In addition to this type of device, a hemodialysis patient can have an artificial prosthesis or catheter installed. They are much inferior in functionality to AVFs, so they are not used often.

The fistula is installed surgically. Before this, it is imperative to undergo diagnostics of the cardiovascular system and establish the usefulness of the kidneys.

Examination and tests

Diagnostic procedures include:

Ultrasound of the cardiovascular system and kidneys;
assessment of heart function;
complex of liver-renal tests;
angiographic examination of the circulatory system;
fluorography;
blood and urine tests (general, biochemical parameters, hepatitis, HIV).

Be sure to tell your doctor if you are taking anti-inflammatory or blood thinning medications, as they may affect the progress of the surgical procedure.

Stages of passage

The installation procedure is simple and, if the doctor is sufficiently experienced, takes no more than an hour. Local anesthesia is used, and the shunt is installed mainly on one arm.

In rare cases, when there are not enough human vessels, the doctor may use special medical catheters or tubes, they replace certain sections of the vein. It takes an average of 30 to 60 days for the fistula to swell; during this period it is strictly forbidden to puncture or injure it.

The essence of the operation is to carry out the following manipulations:

injecting local anesthesia into the patient's arm;
treatment of the incision site;
then the doctor makes an incision in the skin and ligates the necessary artery, then crosses it;
at the next stage, the lateral venous vessel is removed and a clamp is applied to it;
then these two vessels are dissected and stitched together;
At the last stage, the doctor heals the incision on the arm and applies a sterile surgical dressing.

During the operation, the patient does not feel pain; in the future, proper care of this device is very important.

How to care for a fistula

To get an ideal fistula, you need to take care of the venous vessels and not subject them to frequent punctures. There are certain requirements for caring for this device.

Checking status

During the postoperative period, it is necessary to keep the operated arm strictly at rest; it is forbidden to lift heavy things or sleep on this side.

Maintaining personal hygiene

An important condition is compliance with the rules of personal hygiene.

It is necessary to ensure the cleanliness of the hand on which the fistula is installed and periodically treat it with disinfectant solutions.

Protection from injury

It is necessary to protect this device from injuries, as they will provoke severe subcutaneous bleeding. Under no circumstances should blood pressure be measured or given injections on the operated arm.

Free blood flow

When squeezing a hand with an installed fistula, the risk of developing blood clots increases, so you need to wear loose clothing and avoid wearing bracelets, watches or other similar jewelry. It is not recommended to bend your arm too much at the elbow.

Maintaining normal temperature

Severe changes in temperature increase the risk of blood clots, especially for patients with arterial hypertension. Do not overuse baths, saunas or hot baths. These procedures lead to the dilation of blood vessels, as a result of which the pressure drops sharply and the outflow of blood decreases.

During the cold season, the walls of blood vessels narrow and the outflow of blood becomes weaker. In winter, it is recommended to wear warm clothes to avoid hypothermia.

Complications and prognosis

If used incorrectly, the patient may encounter the following complications:

infection;
poor blood flow;
development of chronic heart failure;
blood clot formation;
strokes of ischemic nature;
aneurysm at the site of the fistula.

When the first unpleasant signs appear, you should immediately contact the institution where the operation was performed.

In the absence of associated complications, the installation of an AVF is positive. This also applies to its timely removal.

Conclusion and useful information

To extend its service life, you need to properly care for this structure, carefully treat it after each dialysis session, and consult a doctor for the slightest irregularities.

It is imperative to avoid the development of an infectious process. The first alarming symptoms are: purulent discharge, redness of the skin, external defects. In this case, it is recommended to immediately consult a doctor who will correct the fistula.

Fistula for hemodialysis today is a unique way to improve the process of purifying the blood from toxic substances. It has a number of advantages; with proper care and installation it can last up to 10 years.

It is very important to do this procedure only in a good medical center with experienced specialists; this will significantly reduce the risk of complications.

urohelp.guru

Arteriovenous fistula for hemodialysis, its photo

Fistula for hemodialysis is a modern technique that is highly effective. To ensure continuous hemodialysis (a blood purification method), vascular access is created. To put it simply, a fistula is a fistula through which an artery and a vein can be directly connected.

The very essence of the surgical intervention is that surgeons form an arteriovenous aneurysm that connects a peripheral vein and artery.

Until recently, chronic renal failure was considered a death sentence with an almost 100% fatal outcome. But now the disease is being treated quite successfully.

Why is the procedure performed?

Fistula is necessary for chronic dialysis. Access to the blood circulation is obtained thanks to vascular access, which allows blood purification.

To put it simply, a vascular access essentially creates a kind of opening into which a large amount of blood can be injected or removed.

As a result, the venous walls become much thicker, and the speed of blood movement through the venous vessel is higher. As a result of staging a fistula in a patient with renal failure, it is much easier to connect an artificial kidney machine.

Fistula is a guarantee of a high-quality diagnosis, and there are far fewer complications with it

Thanks to the fistula, the artery and vein are sutured and a vessel with thick walls and good arterial blood flow is created. This vessel is located superficially, it is convenient to puncture it and easy to purify the blood.

During the procedure, the specialist performs stitching on one arm. The peculiarity of the arteries is that they have good blood flow and a deep location, and their puncture is associated with a number of difficulties. Unlike arteries, veins are superficial, accessible and thin, so there will be insufficient blood flow for dialysis. That is why combining them is a wonderful solution to the problem that has arisen.

The vein and artery are sutured on one arm. Although the arteries have good blood flow, they are located deep, so it can be extremely difficult to perform a puncture. On the other hand, the veins, although located superficially, are too thin, which will also cause problems, which is why connecting them is the right solution that will save the situation.

Features of fistula for hemodialysis

Like any procedure, fistula placement has a number of advantages and disadvantages. First, let's talk about the benefits.

"Pros"

The main features of the procedure are the following factors:

the fistula is located directly under the skin;
the fistula is created exclusively from the patient’s tissues;
the risk of infection and thrombosis is reduced to zero;
the ability to operate the system for several years or even decades;
constant updating of methods for staging a fistula, which will improve the procedure itself.

Prolonged maturation of the fistula is the main disadvantage of the procedure

Minuses

There are quite a few disadvantages of the procedure, but you still need to know about them:

the fistula can take one to two months or more to mature;
the fistula may not mature at all. This happens for a number of reasons: insufficient blood flow to the fistula, low blood pressure in the fistula, a small vessel for creating the fistula.

Preparation for the procedure

Before carrying out such an important procedure, it is important to carry out a number of diagnostic studies to assess the patient's condition. Particular attention is paid not only to the state of the cardiovascular system, but also to the functional abilities of the kidneys.

A full and extensive diagnosis must be carried out, which includes:

ultrasound of blood vessels, kidneys, heart;
functional diagnostics of the heart;
renal-hepatic complex;
angiography;
chest x-ray;
general analysis of urine and blood;
analysis for hepatitis, HIV.

A complete diagnosis is the most important stage of preparation

During such a study, specialists determine the state of protein and electrolyte balance, and if this is necessary, adjustments must be made. In addition, the hemoglobin level at the time of surgery should be normal.

The doctor also needs to be informed about the medications you are taking, and if they can cause any problems during surgery, they should be discontinued. In particular, such drugs include anti-inflammatory drugs, as well as drugs that affect blood thinning.

The essence of the operation

Proper operation and installation of a fistula is the key to a successful and speedy recovery! So, the suturing of the vein and artery occurs in the forearm. Why in this area? The fact is that this place is convenient for puncturing.

The result is a vessel that has a superficial location with sufficient arterial blood flow and has thick walls. In addition, an installed fistula is not susceptible to infectious complications and can operate for a very long time - literally several decades.

The procedure is carried out in several stages, namely:

the first thing done is anesthesia;
the future incision site is treated according to all the rules of asepsis and antiseptics;
after exposing the artery, ligation is done, and then intersection;
the next step is mobilization of the lateral vein and further application of clamps;
then the arterial and venous vessels are dissected and sutured;
the wound is sutured;
The final step is to apply a bandage.

How to properly care for a fistula?

When should a patient start caring for a fistula? Actually much sooner than you think. This must be done before surgery.

The photo shows the process of fistula formation

In order to create a fistula, it is necessary that the arteries and veins are well developed, which is why the veins of the forearm need to be protected and punctured less.

Dialysis should begin when the fistula is already mature. Only thanks to this can one hope for long-term and high-quality work of the fistula.

Some patients reach the end of their service life after just a couple of years; in order to extend this time, you must adhere to the following recommendations:

in the postoperative period, especially in the early stages, it is necessary to provide rest to the hand, it is better if it is located on a hill;
If we talk about the later stages of the postoperative period, then the fistula arm should not be overly protected; it is useful and necessary for it to be given moderate physical activity, but in no case should it be given forceful and heavy loads;
every day it is necessary to dry the fistula;
you should listen to the noise coming from the fistula. It should be approximately the same, but if there are any changes, it is better to consult a doctor;
One should not forget about hygiene measures;
You should never sleep on a fistula arm;
Blood pressure should be monitored and sudden changes should be avoided;
There is no need to measure blood pressure or take blood tests on a fistula arm.

Checking the condition of the fistula

Checking should become as routine for you as brushing your teeth in the morning. You should make sure that everything is normal with the fistula by visual inspection, as well as by touch.

The fistula should be kept in good condition as it plays a key role in the success of dialysis

Any signs of redness or swelling are not normal, so you should pay attention to this and tell your doctor at the first changes. A stethoscope can help you hear the characteristic noise and understand how well the blood is flowing. You can ask your medical staff how to do this correctly.

Don't be afraid to touch the fistula gently. You should feel some vibration - this is normal. You should be careful that the fistula should not be warmer than usual, and a light touch should not cause any pain.

The following simple rules will help reduce the likelihood of infection and thrombosis to a minimum.

Do not interfere with free blood flow

If you squeeze the fistula arm, there is a high probability of thrombosis, especially for people with arterial hypotension.

Follow these tips:

Do not wear tight clothes, as well as squeezing watches and bracelets;
You should not bend your arm too much.

Maintaining personal hygiene rules

Personal hygiene rules include the following:

The access area should be washed with plain water, but there should be soap specially provided for this procedure. It is necessary to carry out such a cleansing procedure before dialysis;
The fistula site should not be scratched.

Do not cough or sneeze on your fistula arm.

Protection from injury

Running and cycling are the optimal exercise for a fistula arm. You should not take heavy objects in your hand, it is better to take care of yourself.

Temperature changes are the enemy of fistula

Too high or, conversely, low temperature has an adverse effect on the fistula and can lead to thrombosis. Excessive heat, such as going to a sauna or steam room, causes blood vessels to dilate, causing blood pressure to drop. It is logical that blood flow slows down. Therefore, you should not visit the bathhouse; even in hot weather you need to stay in the shade.

Excessive cold, on the contrary, constricts blood vessels, but also slows down blood flow, so in cold weather you need to dress warmly

In order to increase the use of fistulas, dialysis centers try to adhere to the following provisions, namely:

continuous diagnostics of vascular access;
timely consultation with a nephrologist;
full surgical assessment of fistula options and site;
training of medical personnel to improve their skills regarding puncturing;
evaluation of work results.

Survey

Signs and symptoms of infection include the following:

hyperemia,
discharge,
pus,
defects.

Cold hands, paleness and blueness are clear signs of poor blood flow. On the contrary, a hand that is hot to the touch may indicate the presence of an infection.

As for the noise that is listened to, it must be distinct and continuous, and each subsequent sound must be related to the previous one.

So, fistula for hemodialysis is an innovative technique that has proven high effectiveness. Follow simple recommendations and it will serve you for many years.

2pochki.com

Fistula - Dialysis Clinic

Fistula is a pathological or artificially created opening in the body (Wikipedia). In relation to hemodialysis, it means the method by which the anastomosis of veins and arteries is obtained for further hemodialysis.

Fistula. Introduction

Vascular access should:

Allow repeated access to circulation.

Provide sufficient blood flow for effective hemodialysis.

Be made of a material that does not cause a reaction or predisposition to infection.

The three main types of approaches are: fistula, prosthesis and catheter. When performing a fistula, the surgeon stitches together an artery and vein, most often in the arm. Arteries carry oxygen-rich blood from the heart and lungs to the rest of the body. These vessels chosen for the fistula are large and have good blood flow, but they lie deep under the skin and their puncture is difficult. Veins carry blood back to the heart and lungs. They are located superficially, accessible, but too thin and the blood flow through them is insufficient for dialysis.

Connecting the artery and vein is the best solution to the situation. After 4-6 weeks, high blood pressure and high arterial blood flow lead to thickening of the vein wall and its dilatation (widening). As a result, the vessel can be punctured with thick needles. The fistula is located under the skin and is created only from the patient’s own tissue. Therefore, the fistula is less susceptible to infection and thrombosis, unlike other approaches. A fistula can last for years or even decades. Research has shown that fistula is currently the best available access. New surgical techniques for creating a fistula, puncture techniques, and ways to preserve vessels have made the fistula the preferred option for most patients.

Actions before surgery:

After the condition of the vessels has been assessed and a site for creating access has been selected, the patient should be well informed about the upcoming operation and the rules for postoperative care of the access should be explained in detail. The patient should be aware that the arm with a functioning fistula should not be used for venous puncture or for monitoring blood pressure.

The operation is performed under local, regional or general anesthesia. It is possible to prescribe prophylactic antibiotics before surgery.

Postoperative care for fistula and prosthesis

Immediately after surgery, the surgical area should be examined (initially every half hour) for:

Excessive bleeding;

Swelling;

Warm the extremity to ensure satisfactory peripheral circulation;

The presence of a trill (the sensation of blood buzzing as it flows through the fistula) or a murmur (a whistling sound of blood that can be heard with a stethoscope) clearly indicates the presence of blood flow through the fistula;

To prevent thrombosis, blood pressure should be maintained at an acceptable level and dehydration should be avoided;

The approach should be in an elevated position to avoid excessive edema and swelling.

A few rules for caring for a fistula:

How to apply a fistula

A native arteriovenous fistula (AVF) is created surgically by suturing an artery and vein. This connection is called an anastomosis and a scar is left at the surgical site. It takes 1-3 months until the AVF becomes powerful enough to be punctured with thick needles. Therefore, it is advisable to create a fistula early before the start of hemodialysis.

After the fistula is made, powerful arterial blood flow begins through the vein, which begins to expand the fistula vein and make its wall elastic. This is the arterialization of the fistula, which we call AVF maturation. After about a week, the patient can begin exercises that help the fistula mature. This could be squeezing a rubber ball or lifting light weights.

The most common type of native AVF is an anastomosis between the radial artery and the cephalic vein. Stitching is done on the forearm between the wrist and elbow. This is the so-called radiocephalic fistula.

There are a number of reasons why a patient cannot have an AVF:

Veins damaged due to intravenous drug infusion

Previous operations on arteries and veins

Atherosclerosis: plaque or waxy cholesterol blocks blood vessels

Poor arterial health due to peripheral vascular disease or severe advanced diabetes

The only working artery that brings blood to the hand

Vascular damage from intravenous drug administration.

Advantages and disadvantages of fistula

Advantages: AVF is the gold standard for vascular access. Typically, the fistula lasts longer than other approaches and has fewer complications, including infection. To create an AVF, the patient's own blood vessels are used. If possible, a fistula should always be performed.

Disadvantages: the main disadvantage of a fistula is the long period of its maturation: 4-6 weeks or more. Some fistulas do not mature at all. The problem is called early or primary failure.

The fistula may not mature for the following reasons:

The anastomosis is too small and there is insufficient blood flow into the fistula.

A stenosis has formed between the anastomosis and the entrance to the fistula.

The lateral veins extending from the fistula vein reduce the blood pressure in the fistula and it does not arterialize.

The vessel chosen by the surgeon to create a fistula is too small (< 2 мм).

kcmhd.ru

Fistula for hemodialysis: pros and cons of the technique

Modern medicine does not stand still, and every year scientists are developing the possibilities of creating a full life for a person with almost any disease.

The essence of the technique

Underwater rocks

Fistula also has negative properties. These include its long maturation. It takes at least 1 month to form, and sometimes it doesn’t form at all. This may occur due to its poor blood supply, as well as when the lateral veins depart from the fistula with a decrease in blood pressure. The vessel in which the fistula forms may be too narrow, or a narrowing may form between the entrance to the fistula and the connection of the veins and arteries. To preserve the fistula, it is necessary to limit the number of injections given in the arm on which it is formed before the formation process begins.

Hemodialysis should be carried out on a mature fistula, this is how it can function for a long time, up to 10 years.

apochki.com

Kidney problems? Fistula. What should a hemodialysis patient know?

So, the normal functioning of the body involves the flow of blood from the heart through the arteries into the capillaries, then the movement occurs back through the veins. An arteriovenous fistula is an artificially created anastomosis of an artery and a vein; they are “sutured” - as a result, the blood moves along the communication between the vein and the artery, bypassing the capillary network. Naturally, the blood flow increases, the vein swells - which makes it possible to quickly pump blood through special needles.

Is it possible to do without surgery?

Watch a video about the operation to create an arteriovenous fistula for hemodialysis (if you can hardly stand the sight of blood and “naked” internal organs, it’s better not to watch):

Prepare for dialysis ahead of time

Why is she making so much noise?

A fistula sounds something like this: http://shikur.ru/wp-content/uploads/2012/10/fistula.mp3

From the history of the creation of fistula

A few rules for caring for a fistula:

Check its functioning regularly; the noise of the fistula should be pulsating and uniform.

Take maximum care of the hand with the fistula. Try not to lift weights with it. Do not engage in strength sports - martial arts, exercises with weights, push-ups. Although reasonable loads are needed. At the time of “ripening” of the fistula, doctors even recommend exercises with a manual expander (in the form of a regular rubber ring).

Do not sleep or lie on the arm with the fistula.

Avoid watches, bracelets and other jewelry, clothing that compresses the arm on which hemodialysis access is installed.

Do not measure blood pressure on an arm with a fistula. It is better to perform all punctures and injections on the other hand.

The hemodialysis access area should be kept clean, including lotions, creams and other perfumes.

Cleanliness is especially important on the day of dialysis. Before the session, it is recommended to wash your hand with warm water and soap.

Monitor your blood pressure. Strong jumps in blood pressure do not have the best effect on the condition of the fistula. Do not gain weight too quickly during the interdialysis period.

Any bleeding is a cause for concern. If after a hemodialysis session the bleeding does not stop for a long time, be sure to consult a doctor.

An educational video (USA) talks about the formation of an arteriovenous fistula. If you carefully read the text above, the film will be understandable without words.

Fistula (advice from US specialists)

And also read about dialysis on our website:

* Kidneys failed. What is hemodialysis?

* Kidney problems. How to “get off” dialysis?..

* Kidney diseases are “silent killers”. Professor Kozlovskaya about the problems of nephrology in Russia

* Fistula. What should a hemodialysis patient know?

* Fistula (advice from US specialists)

* Fistula replacement? Artificial human vessels have successfully passed clinical trials

* Dialysis centers in Russia (addresses, e-mails, telephones)

* Delivery for hemodialysis is free?

* Kidneys failed. Delivery for hemodialysis – at the expense of the budget?

* How much does a hemodialysis session cost?

* “Dry weight” on hemodialysis. Do we determine it ourselves or automatically?

* Thirteen years on a homemade artificial kidney?

* Chronic and acute renal failure. From the experience of Belarusian doctors

* A disabled person “ordered” a doctor for “bad” treatment

* Hemodialysis diet: don’t get drunk, don’t eat too much salt, and set the dinner table carefully!

* Kidneys failed. How long do people live on hemodialysis?

* Kidney problems? The dialysis machine can be worn on the arm. Nanofiber mesh

* To prevent blood from clotting during hemodialysis. About heparin and other anticoagulant drugs

* Clexane is a low molecular weight heparin used in hemodialysis

* Kidney failure? What is the difference between hemodialysis (HD) and hemodiafiltration (HDF)?

* Kidney problems? Physical education and sports on hemodialysis

* Is it possible to give birth on hemodialysis? Happiness of motherhood with chronic renal failure

* In Yakutia, round-the-clock transportation of patients for hemodialysis has been organized

* A monument to the doctor who 50 years ago conducted a blood purification session for the first time in the USSR was unveiled

* Blood purification procedure at home? “Home” hemodialysis is officially allowed

shikur.ru

4 Main Types, Features of Care

Fistula for hemodialysis is a very relevant technique, which is highly effective and is a direct connection of a peripheral vein and artery using a fistula.

Not so long ago, renal failure in the chronic stage was considered a death sentence with a high probability of death for the patient, but now this pathology is very successfully amenable to effective treatment.

How to install a fistula

A fistula is formed by connecting an artery and vein by a surgeon. Experts call the connection site an anastomosis, which is marked by the scar left after the operation. The process of maturing a sufficiently strong fistula can take from 1 to 3 months and requires the patient to perform physical exercises. These exercises can be lifting light objects or squeezing an expander.

After the fistula creation process, strong arterial blood flow helps to expand the fistula vein and gives its wall a certain degree of elasticity.

Experts distinguish 4 main types of suturing of veins and arteries:

The side part of the artery and the side part of the vein are sewn together - the initial method of combating pathology. However, quite often such stitching (amostosis) contributed to the development of venous hypertension and caused swelling of the arm;
connection between the side of an artery and the end of a vein. This method has virtually no complications and promotes good blood flow. Such an operation is very complex and requires a highly qualified surgeon;
amastosis from the end of the artery to the side of the vein helps to obtain less blood flow, compared with amastosis from side to side;
suturing the end of the artery and the end of the vein produces the lowest level of blood flow.

To make sure that the fistula is performing its function, the patient must learn to listen with a stethoscope to noises along the entire length of the fistula vein. A low and fairly long sound indicates that there are no problems.

Contraindications for applying a fistula

Experts identify the following reasons prohibiting fistula surgery:

The patient's veins are damaged by infusions of various intravenous medications;
presence of previous surgical interventions on veins and arteries;
the patient has an advanced stage of diabetes;
the presence of atherosclerosis or diseases affecting peripheral vessels;
in the patient’s body, only one artery is fully functioning, connecting to the hand;
human blood vessels are damaged due to drug ingestion.

Features of fistula

Doctors identify the following as the main positive qualities of such an operation:

The fistula is located under the patient’s skin and does not cause discomfort during life;
the building material is the patient's tissue;
the risk of infections or thrombosis entering the body is much lower than when using a catheter or prosthesis;
the formed blood flow system has been functioning for decades;
constant updating of fistula device methods, which contributes to the improvement of the procedure itself.

Rules for caring for a fistula

The process of preparing for a fistula occurs long before the operation itself. The patient should undergo forearm vein puncture as little as possible. The dialysis process starts only when the fistula is fully mature.

For a long and effective service of the fistula, the patient should follow the following recommendations:

After the operation, the hand should be at rest and placed on a slight elevation;
you can’t sleep on a hand with a fistula;
The fistula should be dried daily;
listen to the sound of blood flow, which should be quite low-noise and extended in sound;
use a non-fistula hand to measure pressure levels and draw blood;
maintain normal blood pressure levels;
give the arm with a fistula vein moderate force loads;
observe the rules of personal hygiene;

Personal hygiene rules

Compliance with personal hygiene rules is very important for a patient with a fistula and consists of the following recommendations:

Do not scratch the fistula vein under any circumstances;
before the dialysis procedure, thoroughly wash with water and special soap;
the doctor performing the dialysis procedure must change his gloves if he touches his face or other surface with them;

A fistula for a hemodialysis procedure, like, in principle, any treatment method, has its undesirable consequences. Due to the fact that blood to the pulmonary artery passes through the fistula, the heart muscle may not receive the required amount of oxygen. But at the same time, this technique restored kidney function and saved the lives of more than one million people on the entire planet.

pochkam.ru

Previously, kidney failure was a fatal disease. She is now being treated with a procedure called hemodialysis. This method is used in cases of acute and chronic stages of pathology. The procedure is carried out using a device called an “artificial kidney”. During the process, toxic metabolic components such as urea, creatine and others are eliminated. Water and electrolyte balance is also normalized.

Procedure

So, fistula - what is it? connected to the patient’s bloodstream through a vascular access created by the surgeon. It is called: arteriovenous fistula (AVF). To connect the device, punctures are made with special needles connected to the dialyzer using a system of tubes. Minimum hemodialysis is prescribed for 12 hours a week, that is, 3 times for 4 hours. This procedure can continue for decades. It allows partial replacement of renal function and allows a person to maintain working capacity and maintain a full life.

Purpose

Chronic dialysis can be performed using venous access. Thanks to it, a place is created for the infusion and removal of a large volume of blood. During the operation, veins and arteries are sutured to create a single vessel with thick walls. In addition, good blood flow is formed in it, which is located superficially, which makes it convenient for puncturing and performing the procedure. Most often, a hemodialysis fistula is formed on the arm. This is due to the fact that there are large vessels with good blood flow. However, they are located deep, which creates difficulties for puncture. Veins, on the contrary, run along the surface, but their walls are too thin. That is why the best option is to stitch these vessels together. In this case, hemodialysis gives the best results. The puncture is carried out with special needles, then a device is connected to the bloodstream through the AVF.

Advantages

No artificial materials are required to create it. After all, what is a fistula? This is a formation consisting of human tissue. The absence of artificial inclusions makes it possible to protect the arteriovenous fistula from infectious complications or thrombosis. It is located just under the skin. The hemodialysis method is preferred by many patients, as it gives results over a long period of time. Today, fistula - what is it? For many professionals and patients, this is the best way to access the bloodstream. Also in its creation, new methods have appeared, methods of puncture and preservation of blood vessels have been improved.

Negative points

The main disadvantage of a fistula is its long maturation, which ranges from one and a half months or more. Sometimes the goal cannot be achieved at all. The so-called early failure occurs for the following reasons:

1. A small flow of blood enters the formation.

2. Lack of arterialization of blood due to a decrease in its pressure in the lateral veins that extend from the fistula.

3. The vessel selected for fistula formation is less than 2 mm.

4. Formation of stenosis between the entrance to the fistula and the anastomosis.

Preservation of education

It is recommended to take care of the fistula before it forms. To do this, it is necessary to protect the vessels of the forearm from unnecessary injections. This will allow the arteries and veins to be in a developed state before creating a fistula.

Dialysis is carried out with an already formed and mature fistula. This will ensure its continued operation for decades. However, there are patients in whom this access tends to be exhausted even earlier (after 2 years).

When the hemodialysis fistula is at the stage of its maturation, the hand should be protected from unnecessary stress. This applies to the postoperative period (before the sutures are removed). Thanks to this, swelling after surgery will go away much faster. It is necessary to exclude physical exercises (barbell, push-ups, etc.). In addition, it is recommended to dry the fistula every day. It is also advised to listen to its noise; it should be the same all the time. If any changes occur, you should consult a doctor. When donating blood for analysis, it is taken from the non-fistula arm. It is not recommended to tighten the formation with a tourniquet. In addition, you should not measure blood pressure on this arm and you should try to prevent it from dropping sharply.

Pulmonary fistula

It should be said that this education does not always benefit the body. For example, the presence of a pulmonary fistula in the coronary system can cause serious problems. Since a certain volume of blood rushes through the fistula to the pulmonary artery, this provokes depletion of blood flow, resulting in a deficiency of nutritional compounds and oxygen in the heart muscle.

Fistula is a pathology in various organs, the formation of ruptures in the body (fistulas), or an artificially created hole. Recognize many species and their locations. What's happened?

What are the health risks? Why are artificial ones needed? Our article is about this and much more.

Brain or spinal cord

The dural arteriovenous is the union of two blood vessels (artery and vein). It occurs in the brain or spinal cord. There are multiple and single.

They are often located at the branch of the carotid and vertebral arteries. In fistulas, the blood flow is large, its venous component is a varicose vein, a reverse flow.

Manifested by bleeding in the brain. Severe headaches appear, blood pressure drops, tinnitus develops, and loss of vision develops. Symptoms similar to stroke.

With spinal dural fistulas, there is compression of the nerve endings, which leads to neurological disorders. The disease progresses slowly, paresis and paralysis of the arms and legs appear, and sensitivity of the limbs is lost. Bladder and bowel functions are impaired.

Coronary-pulmonary

Congenital pathology, which began to be determined thanks to the latest technologies. The heart is an organ that functions without stopping, its task is to pump blood.

The greatest work is performed by the heart muscle, which receives nutrition from the coronary vessels. Violation of them leads to heart attacks.

There is such a pathology when an extra vessel appears in the system; it connects the coronary and pulmonary arteries. A person has two circles of blood circulation - large and small.

They are isolated from each other. The latter type is also called pulmonary, in it the blood is under lower pressure than in high pressure. The coronary fistula that connected both pumps it.

For the lungs, this does not matter, but the heart muscle does not receive oxygen. In terms of size, a coronary pulmonary fistula is usually small in size and does not cause much damage to the body.

In rare cases, a pulmonary fistula can be quite large, or there are several of them, in which case surgical intervention is necessary. In most cases, no treatment is prescribed; it is considered a minor anomaly.

Aortopulmonary

A hemodynamic defect resembling a septal defect in the ventricles of the heart. The shunt is directed from the aorta to the pulmonary artery; when the pressure in the vessels is modified, the flow of blood changes.

It is difficult to distinguish a fistula from a defect in the ventricular septum. The main diseases are pulmonary artery stenosis. If the defect is large, hypertension of the organ may develop. Treatment depends on size.

Fistula after mitral valve replacement surgery

Congenital anomalies lead to numerous interventions for its prosthetics. Complications often arise, one of which is a paraprosthetic fistula.

Small size may not cause clinical manifestations. Large ones lead to heart failure, severe symptoms, and the need for repeated surgery.

Surgeries to remove a mitral valve defect often involve serious complications and are life-threatening. Recently, progressive techniques have appeared for closing a paraprosthetic fistula, without repeated surgery.

For this, advanced technologies are used - umbrella devices, various spirals. The method is called endovascular closure. The device is inserted into the heart through a vein.

After the operation, the patient leaves the hospital a few days later. Rehabilitation proceeds without complications.

Middle ear

A perilymphatic fistula forms in the hearing organs. The membrane (tympanic membrane), which is located in the labyrinth and protects it from the perilymph, can rupture, a fistula is formed.

This happens after injuries, wounds, chronic inflammatory processes, or physical rupture of the eardrum. When a perilymphatic fistula occurs, there may be a sharp pop, followed by dizziness, noise, and hearing loss.

During an examination, an ENT doctor often detects an injury to the membrane, but there is a labyrinthine fistula, when it cannot be visually detected.

Scarring, in most cases, occurs on its own. For this, the patient is prescribed medication. In severe cases, surgical intervention is performed.

Plastic is made from fabric. In the early stages of the disease, the prognosis for recovery is positive.

Pleura in the lung

Pyothorax without fistula (empyema) is purulent inflammation in the pleural cavity. The disease can be a complication of the pathological process in the pericardium or occur independently. Characterized by the accumulation of large amounts of pus.

Causes:

Pneumonia, bronchitis.
Foci of lung tissue pathology (abscess).
Koch bacillus (tuberculosis).
Disease of the mediastinal tissue (mediastinitis).

The disease is manifested by a serious condition of the patient, with pronounced signs:

High temperature, fever.
Weakness and sweating.
Heavy breathing, suffocation, heart rhythm disturbances.
Symptoms of body poisoning are nausea, lack of appetite, migraine.
Increased chest pain when breathing.

With this disease, there may be two types of cough - dry and wet. The first develops when the pleura is intact, when purulent masses are in the cavity. The last one is when pyothorax with a fistula appears.

Cough produces phlegm. Severe complications arise, including cardiac ones. If signs are detected, it is necessary to begin drug treatment and drainage of the lung, during which the accumulated pus will be pumped out.

Therapy is long-term and requires the right approach. If there is no improvement in the first two months, surgical intervention is necessary.

For hemodialysis

A fistula in any organ is considered an anomaly, but with this procedure it is a new technique for cleansing toxins. Thanks to this, a fistula is artificially created, which connects venous and arterial blood and promotes rapid cleansing.

Once in the bloodstream, hemodialysis is faster and more effective. The process of forming a fistula involves surgically creating an extension where a vein and an artery connect.

This is a necessary measure in case of kidney failure, when the kidneys are not able to independently cleanse the body of toxins. Helps quickly connect the patient to the machine - artificial kidney.

The fistula is formed from the patient’s tissues and is located under his skin. It is always accessible, which simplifies the connection process.

Enough time must pass from the moment of surgery for a fistula to form; it is usually done on the shoulder. After its appearance, special care is required. Look for new articles on our website.