Advice from American experts. Kidney problems? Fistula

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

The essence of the technique

Until 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 apparatus, 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 is formed on the arm of the patient. They call it an arteriovenous fistula. It is connected with needles and special tubes. This method allows a person to replace part of the kidney function and he can maintain a normal lifestyle.

During dialysis, a place is created for the infusion of blood, as well as its removal. Blood volumes can be large. To create such a device, surgeons sew arteries and veins together. Thus, a vessel with thick walls and good blood flow is formed. The creation of a fistula does not require the use of artificial materials, it is created directly from human tissues. This is very important, as it helps to avoid infection and the formation of blood clots. The fistula itself is located directly under the patient's skin. This method is preferred by patients in the treatment process. This is the safest and most efficient access to blood flow.

Underwater rocks

The fistula also has negative properties. These include its long maturation. It is formed for at least 1 month, and sometimes it does not form at all. This may be due to its poor blood supply, as well as the departure of the lateral veins from the fistula with a decrease in blood pressure. The vessel in which the fistula forms may be too narrow, or there may be a narrowing between the entrance to the fistula and the junction of the veins and arteries.
In order to save the fistula, it is necessary to limit the number of injections given into the arm on which it is formed before the process of its formation begins.

Hemodialysis should be carried out already 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 of its formation cannot be clamped. Blood for analysis during this period is taken from the other hand.

The patient must constantly monitor blood pressure, as it should not fall sharply. Doctors recommend listening to the sound of the emerging fistula, it must be even. If the patient feels his change, you should immediately contact your doctor.

A hemodialysis fistula can cause some serious health problems. After all, the volume of blood goes 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, 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 with 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. Unfamiliar to most people, the word means "vascular access" - a place from where a significant amount of blood is taken for purification in the "artificial kidney" apparatus and where it is returned already cleansed of toxins. Usually this is the hand, forearm, although, if necessary, there may be other human organs.

So, the normal functioning of the body implies the flow of blood flow from the heart through the arteries to the capillaries, then the movement occurs through the veins back. An arteriovenous fistula is an artificially created anastomosis of an artery and a vein, they are "sewn together" - as a result, the blood moves along the message between the vein and 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 a day after the operation. A fistula formed "naturally" must be protected. It is not recommended to prick it for at least a month. The fistula should “ripen”, swell with blood. Otherwise, the artificially created anastomosis of the artery and vein may be disturbed, the fistula will “stop”.

Watch a video about the operation to create an arterio-venous 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 rest of the life of a dialysis patient, experts recommend forming a fistula in advance, on a planned basis, several months before the start of dialysis. This guarantees many years of operation of the fistula and the absence of additional problems on hemodialysis.

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

Why is she making such a noise?

It is quite easy to recognize a beginner with a newly formed fistula - as a rule, the patient “listens” to her every now and then. To do this, it is enough to press the operated hand to the 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. It pumps blood through swollen veins. The noise must be rhythmic and always the same. With any change in sound, you must immediately show your doctor. And if suddenly the noise disappeared, urgently go to the dialysis center - the fistula could stop, clot. Sometimes blood clots can be removed surgically or medically.

A fistula sounds something like this:

- From the history of the creation of the fistula

No wonder 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 early years of dialysis, scientists had to deal with this problem pretty much. At first, a cannula was used as a vascular access - a tube that was surgically fixed, "attached" 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 implantation of two thin-walled Teflon tubes into the radial artery and saphenous vein. The outer ends of the shunt were connected with 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) for the formation of an arteriovenous fistula (nephrologists Cimino and Brescia - the authorship is disputed), which is currently 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.

- A few rules for caring for a fistula:

- Regularly check its functioning, the noise of the fistula should be pulsating, uniform.

- Protect the hand with the fistula as much as possible. Try not to lift heavy things with it. Do not engage in power sports - martial arts, exercises with weights, push-ups from the floor. Though reasonable loadings are necessary. At the time of the "maturation" of the fistula, doctors even recommend classes with a manual expander (in the form of an ordinary rubber ring).

- Do not sleep and do not lie on the arm with a fistula.

- Avoid watches, bracelets and other jewelry, clothes that squeeze the hand on which the hemodialysis access is installed.

— Do not measure blood pressure on the arm with the fistula. All punctures, injections are best done on the other hand.

- The hemodialysis access area should be kept clean, excluding, among other things, lotions, creams and other perfumes.

— Of particular importance is 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 cause for concern. If after a session of hemodialysis the blood does not stop for a long time, be sure to consult your doctor.

Educational video (USA) tells about the formation of an arterio-venous fistula. If you carefully read the text above, the film will be clear without words.

The translation into Russian of the next remarkable work was published in March 2010 by a well-known specialist in hemodialysis, author of several books, Doctor of Medical Sciences Evgeny Aleksandrovich Stetsyuk (website "Hemodialysis for Specialists", www.hd13.ru). However, the work has not lost its relevance so far. It is written for practicing doctors, but the language will 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 hemodialysis fistula: care and tips

The kidneys are one of the most important organs of the entire excretory system. In case of violation of their work, a person develops serious pathologies.

In the event of insufficiency, the patient is prescribed a hemodialysis procedure.

During its implementation, 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 acute or chronic insufficiency. With such a disease, the body cannot cope with its functions and toxins accumulate in the body along with urine.

Consider the essence of the hemodialysis procedure: with the help of a special drug, the patient's blood is cleansed of toxic substances, water and electrolyte balance is being established.

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

Thanks to this adaptation, 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 on the artery and vein are sewn together. Based on the anatomical structure, blood moves faster through the arterial vessels, and they are located much deeper than the venous ones.

This is what causes difficulties during the taking of the puncture. Doctors have found a unique method of inserting a fistula that simplifies the blood purification process. It should be noted that the stitching of the vessels is carried out only on one arm.

Indications for use

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

acute or chronic kidney failure;
imbalance of electrolytes in the body;
puffiness;
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 placed between an artery and a vein. Thus, the sealing of the walls of blood vessels is ensured and the process of cleansing the blood of toxins is accelerated.

It is located under the skin, does not undergo 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, a radial and brachial fistula is 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 clearly under the skin;
infection and the formation of blood clots are excluded;
with proper care can be used up to 10 years;
scientists are constantly improving this device.

The disadvantages include:

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

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

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

Examination and analyzes

Among the diagnostic procedures are:

Ultrasound of the cardiovascular system and kidneys;
assessment of the work of the heart;
a complex of hepatic-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 drugs, as they may affect the course of the surgery.

Stages of passing

The installation procedure is simple, with sufficient experience of the doctor takes no more than an hour. Local anesthesia is used, the installation of the shunt is carried out mainly on one arm.

In rare cases, when there are not enough human vessels, the doctor can use special medical catheters or tubes, they replace certain parts 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 pierce or injure it.

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

introduction of local anesthesia into the patient's arm;
processing of the incision site;
then the doctor makes an incision of the skin and bandages the necessary artery, then performs its intersection;
at the next stage, the lateral venous vessel is removed and a clamp is applied to it;
further, these two vessels are dissected and sewn together;
at the last stage, the doctor heals the incision on the arm and applies a sterile surgical bandage.

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 obtain an ideal fistula, it is necessary to carefully treat the venous vessels and not subject them to frequent piercing. There are certain requirements for the care of this device.

Status check

In the postoperative period, it is necessary to keep the operated arm in strict rest, it is forbidden to lift heavy things or sleep on this side.

Personal hygiene

An important condition is the observance of the rules of personal hygiene.

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

Injury Protection

It is necessary to protect this device from injuries, as they will provoke severe subcutaneous bleeding. In no case should you measure blood pressure or give injections on the operated arm.

Free blood flow

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

Maintaining normal temperature

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

In 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 improperly, the patient may experience the following complications:

infection;
weak blood flow;
development of chronic heart failure;
thrombus formation;
ischemic strokes;
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 concomitant complications, the installation of AVF is positive. This also applies to its timely removal.

Conclusion and useful information

To prolong the service life, you need to properly care for this design, carefully process it after each dialysis session, and consult a doctor if there is the slightest violation.

Be sure 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 contact a doctor who will correct the fistula.

Fistula for hemodialysis today is a unique way to improve the processes of blood purification 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, her photo

Fistula for hemodialysis is a modern technique with high efficiency. To ensure continuous hemodialysis (blood purification method), a vascular access is created. To put it simply, a fistula is a fistula, thanks to which you can directly connect an artery and a vein.

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

More recently, chronic renal failure was considered a verdict with an almost one hundred percent fatal outcome. But now the disease is being treated quite successfully.

What is the procedure for?

A fistula is essential for chronic dialysis. Access to blood circulation is obtained due to vascular access, which allows for blood purification.

To put it simply, vascular access, in fact, creates a kind of hole where you can both pour in a large amount of blood and extract it.

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 the fistula of a patient with renal insufficiency, it is much easier to connect the “artificial kidney” device.

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

Thanks to the fistula, the artery and vein are stitched together 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 it is easy to clean the blood.

During the procedure, the specialist performs stitching on one arm. The peculiarity of the arteries is that they are distinguished by good blood flow and deep location, and their puncture is associated with a number of difficulties. Unlike arteries, veins are superficial, accessible and thin, so blood flow will not be sufficient for dialysis. That is why their connection is a wonderful solution to the problem that has arisen.

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

Features of a fistula for hemodialysis

Like any procedure, fistula staging 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 tissues of the patient;
the risk of infection and thrombosis is reduced to zero;
the possibility of the system functioning for several years or even decades;
constant updating of the methods of setting the 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 mature for one or two months or more;
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 to create a 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 should 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

In the course of such a study, specialists determine the state of the protein and electrolyte balance, and if this is necessary, then an adjustment should take place. In addition, the level of hemoglobin at the time of surgery should be normal.

The doctor should also be informed about the medications taken, and if they can cause any problems during the surgical procedure, then they should be discontinued. In particular, these 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 stitching of the vein and artery occurs in the forearm. Why in this particular 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, the established fistula is not subject to infectious complications and is able to act for a very long time - literally several decades.

The procedure is carried out in several stages, namely:

the first thing that is done is anesthesia;
the future incision site is processed according to all the rules of asepsis and antisepsis;
after exposure of the artery, ligation is done, and then the intersection;
the next step is the mobilization of the lateral vein and the further application of clamps;
then there is a dissection of arterial and venous vessels and stitching;
the wound is sutured;
The final step is the application of 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 must be protected and less punctured.

Dialysis should begin with an already mature fistula. Only thanks to this, we can hope for a long and high-quality work of the fistula.

In some patients, in just a couple of years, the service life is exhausted, in order to extend this time, it is necessary to adhere to the following recommendations:

in the postoperative period, especially in the early stages, it is necessary to provide peace to the hand, it is better if it is on a hill;
if we talk about the later terms of the postoperative period, then the fistula hand should not be excessively protected, it is useful and necessary to give it moderate physical activity, but in no case should it be given power and heavy loads;
every day it is necessary to dry the fistula;
you should listen to the noise that comes from the fistula. It should be about the same, if there are any changes, then it is better to consult a doctor;
do not forget about hygiene measures;
in no case should you sleep on a fistula arm;
blood pressure should be controlled and sudden drops should be avoided;
on a fistula arm, you should not measure pressure and take blood for tests.

Checking the condition of the fistula

Checking should become as habitual for you as brushing your teeth in the morning. You need to make sure that the fistula is normal 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 inform your doctor at the first changes. A stethoscope can help you hear the characteristic noise and understand how good the blood flow is. You can ask medical staff how to do it right.

Don't be afraid to gently touch the fistula. You should feel some vibration - this is normal. You must 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 minimize the likelihood of infection and thrombosis.

Don't obstruct free blood flow

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

Stick to the following tips:

do not wear tight clothing, as well as squeezing watches and bracelets;
do not bend your arm too much.

Compliance with the rules of personal hygiene

Personal hygiene rules include the following:

the access point should be washed with plain water, but there should be soap specially designated for this procedure. It is necessary to carry out such a cleansing procedure before dialysis;
the site of the fistula should not be combed.

Avoid coughing and sneezing into a fistulous hand

Injury Protection

Running and cycling are the optimal load for a fistulous hand. Do not take heavy objects in your hand, it is better to take care of yourself.

Temperature drops are the enemy of the fistula

Too high or, conversely, low temperature adversely affects the fistula and can lead to thrombosis. Excessive heat, such as going to the sauna or bath, causes the blood vessels to dilate, causing blood pressure to drop. It is logical that the 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 warmer

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

ongoing diagnosis of vascular access;
timely consultation with a nephrologist;
full surgical assessment of the possibilities of fistula and site imposition;
training of medical personnel to improve their skills in relation to puncture;
performance evaluation.

Survey

Signs and symptoms of infection are:

hyperemia,
selection,
pus,
defects.

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

As for the noise that is heard, it should be distinct and continuous, and each subsequent sound should be connected with the previous one.

So, the fistula in hemodialysis is an innovative technique that has proven to be highly effective. Stick to simple recommendations, and it will serve you for many years.

2pochki.com

fistula - Dialysis Clinic

Fistula - a pathological or artificially created opening in the body (Wikipedia). With regard to hemodialysis, it means the way in which the fistula of the vein and artery is obtained for further hemodialysis.

Fistula. Introduction

Vascular access should:

Allow repeated circulation accesses.

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 access are: fistula, prosthesis and catheter. When applying a fistula, the surgeon sews together an artery and a 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 are difficult to puncture. 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.

The connection of an artery and a vein is the best solution to the situation. After 4-6 weeks, high pressure and high arterial blood flow lead to thickening of the vein wall and its dilatation (expansion). As a result, the vessel can be punctured with thick needles. The fistula is located under the skin and is created only from the tissues of the patient himself. Therefore, the fistula is less prone to infection and thrombosis, unlike other approaches. The fistula can work for years and even decades. Research has shown that the fistula is currently the best approach available. New surgical techniques for creating a fistula, puncture techniques, and vascular preservation techniques have made the fistula the preferred choice for most patients.

Steps before surgery:

After the state of the vessels has been assessed, the place for creating an access has been chosen, the patient should be well informed about the upcoming operation and the rules of postoperative care for the access should be explained in detail. The patient should be aware that an arm with a functioning fistula should not be used to puncture a vein and to monitor blood pressure.

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

Postoperative care of fistula and prosthesis

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

excessive bleeding;

swelling;

Warmth of the limb, to ensure that there is a satisfactory peripheral circulation;

The presence of a trill (the sensation of a buzzing of blood as it flows through the fistula) or murmur (a whistle 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 not be allowed;

The access must be in an elevated position to avoid excess edema and swelling.

A few rules for caring for a fistula:

How to make a fistula

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

After the fistula is made, a 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 performed on the forearm between the wrist and elbow. This is the so-called radiocephalic fistula.

There are a number of reasons why an AVF cannot be placed on a patient:

Veins damaged due to infusion of intravenous drugs

Previous surgeries 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 injury from intravenous drug use.

Advantages and disadvantages of a fistula

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

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

The fistula may not mature for the following reasons:

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

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

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

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

kcmhd.ru

Fistula for hemodialysis: the pros and cons of the technique

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

The essence of the technique

Underwater rocks

Hemodialysis should be carried out already 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 patient on hemodialysis know?

Is it possible to do without surgery?

Watch a video about the operation to create an arterio-venous fistula for hemodialysis (if you can hardly stand the sight of blood and "naked" internal organs, it's better not to watch):

Get ready for dialysis early

True, most patients get on dialysis too late - when the body is already poisoned with toxins due to poorly functioning kidneys and when the bill 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 on the neck and carrying blood away from the neck and head.

Why is she making such a noise?

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

From the history of the fistula

A few rules for caring for a fistula:

Regularly check its functioning, the noise of the fistula should be pulsating, uniform.

Protect the hand with the fistula as much as possible. Try not to lift heavy things with it. Do not engage in power sports - martial arts, exercises with weights, push-ups from the floor. Though reasonable loadings are necessary. At the time of the "maturation" of the fistula, doctors even recommend classes with a manual expander (in the form of an ordinary rubber ring).

Do not sleep or lie on your arm with a fistula.

Exclude watches, bracelets and other jewelry, clothes that squeeze the hand on which the hemodialysis access is installed.

Do not measure blood pressure on an arm with a fistula. All punctures, injections are best done on the other hand.

The area of hemodialysis access should be kept clean, excluding, among other things, lotions, creams and other perfumes.

Of particular importance is 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 cause for concern. If after a session of hemodialysis the blood does not stop for a long time, be sure to consult your doctor.

Educational video (USA) tells about the formation of an arterio-venous fistula. If you carefully read the text above, the film will be clear without words.

Fistula (Advice from US Specialists)

And also read about dialysis on our website:

* Kidney failure. What is hemodialysis?

* Kidney problems. How to jump off dialysis?

* Kidney disease is a silent killer. Professor Kozlovskaya about the problems of nephrology in Russia

* Fistula. What should a patient on hemodialysis know?

* Fistula (Advice from US experts)

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

* Dialysis centers in Russia (addresses, e-mail, phones)

* Delivery to hemodialysis - free of charge?

* Kidney failure. Delivery for hemodialysis - at the expense of the budget?

* How much does a hemodialysis session cost?

* "Dry weight" on hemodialysis. Do we define 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 salt, and set your dinner table carefully!

* Kidney failure. How long do people live on hemodialysis?

* Problems with the kidneys? The dialysis machine can be worn on the arm. Nanofiber nets

* To prevent blood clotting on hemodialysis. About heparin and other anticoagulants

* Clexane is a low molecular weight heparin used in hemodialysis.

* Kidney failure? How is hemodialysis (HD) different from hemodiafiltration (HDF)?

* Problems with the kidneys? Physical education and sports on hemodialysis

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

* Round-the-clock transportation of patients for hemodialysis is organized in Yakutia

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

* Blood purification procedure at home? Officially allowed "home" hemodialysis

shikur.ru

4 Main Types, Care Features

The fistula for hemodialysis is a very relevant technique, which has a high degree of efficiency and is a direct connection of a peripheral vein and artery using a fistula.

Not so long ago, chronic renal failure was considered a verdict with a high probability of death of the patient, but now this pathology is very successfully treated with effective treatment.

How is a fistula placed?

A fistula is formed by connecting an artery and a vein by a surgeon. Specialists call the junction an anastomosis, which stands out as a scar left after the operation. The process of maturation of 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 process of creating a fistula, a strong arterial blood flow contributes to the expansion of the fistula vein and gives its wall a certain degree of elasticity.

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

The lateral part of the artery and the lateral part of the vein are sutured - the initial method of dealing with pathology. However, quite often, such stitching (amostosis) contributed to the development of venous hypertension and caused swelling of the hand;
connection of the lateral part of the artery and the end of the vein. This method has practically no complications and promotes good blood flow. Such an operation is very complex and requires a high degree of skill from the surgeon;
amastosis of the end of the artery into the lateral part of the vein contributes to less blood flow, in comparison with amostosis side to side;
suturing the end of an artery and the end of a vein gives 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 for noises along the entire length of the fistula vein. A low and rather long sound indicates that there is no problem.

Contraindications for fistula

To the reasons forbidding the operation on the device of the fistula, experts distinguish the following:

The patient's veins are damaged by infusions of various intravenous medications;
the presence of previous surgical interventions on the 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, which connects to the hand, is fully functioning;
blood vessels of a person are damaged due to the ingestion of drugs into the vein.

Features of a fistula

The main positive qualities of such an operation, doctors distinguish the following:

The fistula is located under the skin of the patient and does not cause discomfort in the process of life;
the building material is the tissues of the patient;
the risk of introducing infections or thrombosis into the body is much lower than when using a catheter or prosthesis;
the formed blood flow system has been functioning for decades;
continuous updating of fistula device methods, which contributes to the improvement of the procedure itself.

Fistula Care Rules

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

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

After the operation, the hand should be at rest and located on a small hill;
you can not sleep on a hand with a fistula;
the fistula should be dried daily;
listen to the sound of the blood flow, which should be quite quiet and extended in its sound;
to measure the level of pressure and blood sampling, use a non-fistula arm;
maintain normal blood pressure levels;
give the arm with the fistula vein moderate power loads;
observe the rules of personal hygiene;

Personal hygiene rules

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

Never scratch the fistula vein;
before the dialysis procedure, thoroughly washed with water and special soap;
the doctor performing the dialysis procedure must change his gloves if he touches them to the face or other surface;

A fistula for the hemodialysis procedure, as, in principle, any treatment method has its undesirable consequences. Due to the fact that the 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

In the past, 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. A procedure is carried out with an apparatus called "artificial kidney". During the process, toxic components of metabolism, such as urea, creatine and others, are removed. Water and electrolyte balance is also normalized.

Procedure

So, fistula - what is it? connected to the patient's bloodstream through a vascular access, which is created by the surgeon. It's called an arteriovenous fistula (AVF). To connect the device, punctures are made with special needles connected to the dialyzer using a tube system. Minimum hemodialysis is prescribed for 12 hours a week, that is, 3 times for 4 hours. This process can take decades. It allows you to partially replace the renal function and enables a person to maintain working capacity and maintain a full life.

purpose

With the help of venous access, chronic dialysis can be performed. Thanks to him, 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, a good blood flow is formed in it, which is located superficially, which creates convenience for puncture and 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, pass over 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 highest result. The puncture is performed with special needles, then the device is connected to the bloodstream through the AVF.

Advantages

It does not require artificial materials to create it. After all, a fistula - what is it? This is a formation consisting of human tissues. The absence of artificial inclusions helps to protect the arteriovenous fistula from infectious complications or thrombosis. It is located just under the skin. The method of hemodialysis is preferred by many patients, as it gives results over a long period of time. Today, a fistula - what is it? For many professionals and patients, this is the best way to access blood flow. Also in its creation, new methods have appeared, methods of puncture and preservation of blood vessels are being improved.

Negative points

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

1. The entry of a small blood flow into the formation.

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

3. The vessel chosen to form the fistula is less than 2mm.

4. The formation of stenosis between the entrance to the fistula and the anastomosis.

Preservation of education

It is recommended to take care of the fistula even before its formation. To do this, it is necessary to protect the vessels of the forearm from unnecessary injections. This will allow the arteries and veins to develop before the fistula is created.

Dialysis is performed with an already formed and mature fistula. This can ensure the duration of its work for decades. However, there are such patients in whom this access tends to be exhausted even earlier (after 2 years).

When the fistula for hemodialysis is at the stage of its maturation, the hand should be protected from unnecessary stress. This applies to the postoperative period (before the removal of sutures). Due to this, swelling after surgery will pass 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 constantly the same. In the event that any changes occur, you should consult a doctor. When donating blood for analysis, it is taken from a non-fistulous arm. It is not recommended to pull the formation with a tourniquet. In addition, you can not measure blood pressure on this arm and you should try not to allow it to drop 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 a depletion of blood flow, resulting in a deficiency of nutrients and oxygen in the heart muscle.

Fistula - a pathology in various organs, the formation of gaps in the body (fistula), or an artificially created hole. Recognize many species and their places of localization. What?

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

brain or spinal cord

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

Often they are located on a branch of the carotid and vertebral arteries. In fistulas, the blood flow is large, its venous component is a varicose expansion, a reverse flow.

Manifested by hemorrhage in the brain. Severe headaches appear, pressure drops, tinnitus develops, loss of vision. The symptoms are similar to those of a stroke.

With spinal dural fistulas, nerve endings are compressed, which leads to neurological disorders. The disease progresses slowly, paresis and paralysis of the arms and legs appear, the sensitivity of the limbs is lost. Functions of a bladder and intestines are broken.

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 done 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 which the blood is under less pressure than in the large one. The coronary fistula that connected the two is pumping her.

For the lungs, it doesn't matter, but the heart muscle doesn't get enough oxygen. The 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 of considerable size, or there are several of them, then surgery is necessary. In most cases, treatment is not prescribed, it is considered a minor anomaly.

Aorto-pulmonary

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 blood flow changes.

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

Fistula after mitral valve replacement surgery

Congenital anomalies lead to numerous interventions for its prosthetics. Often there are complications, one of which is a paraprosthetic fistula.

Small size may not give clinical manifestations. A large one leads to heart failure, severe symptoms, the need for a second operation.

Operations to remove a defect in the mitral valve often occur with serious complications and are life-threatening. Recently, progressive techniques have appeared to close the paraprosthetic fistula, without reoperation.

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 after a few days. Rehabilitation proceeds without complications.

middle ear

Perilymphatic fistula is formed in the organs of hearing. The membrane (tympanic membrane), which is located in the labyrinth and protects it from the perilymph, can be torn, a fistula is formed.

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

An ENT doctor during examination often detects a membrane injury, but there is a labyrinth fistula when it cannot be visually detected.

Scarring of it, in most cases, occurs independently. For this, the patient is prescribed medication. In severe cases, surgery 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 a purulent inflammation in the pleural cavity. Diseases can be a complication of the pathological process in the pericardial sac (pericardium), occur independently. It is characterized by the accumulation of a large amount of pus.

Causes of occurrence:

Pneumonia, bronchitis.
Foci of lung tissue pathology (abscess).
Koch's wand (tuberculosis).
Mediastinal fiber disease (mediastinitis).

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

High temperature, fever.
Weakness and sweating.
Heavy breathing, choking, heart rhythm disturbance.
Symptoms of poisoning of the body - nausea, lack of appetite, migraine.
Increased chest pain on breathing.

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

Coughing up sputum. There are serious complications, including cardiological ones. If signs are found, it is necessary to start medical treatment and drainage of the lung, in which the accumulated pus will be pumped out.

The therapy is long, requiring 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 method of cleansing toxins. Thanks to this, a fistula is artificially created, which connects venous and arterial blood, and contributes to the fastest cleaning.

Once in the bloodstream, hemodialysis is faster and more efficient. The process of fistula formation is that an expansion is created surgically, where the vein and artery connect.

This is a necessary measure for kidney failure, when the kidneys are not able to cleanse the body of toxins on their own. Helps to quickly connect the patient to the device - an artificial kidney.

The fistula is formed from the tissues of the patient and is located under his skin. There is always access to it, which facilitates the connection process.

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