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Welcome
to
Haemodialysis Simplified
Session 3: Care of Arterial Venous Fistula
Ramachandran Chellan
Learning Objectives
 General Care of AV Fistula
 First cannulation and post dialysis AVF care
 Warning signs to look for ..
 Investigations , if required
 De-clotting of AVF , if required
 Emergency care , in case of unexpected bleeding
General Care
Self care: By patient
 Keep Fistula clean , wash everyday with soap and water
 Do not use a scrubber
Do not obstruct fistula flow
Do not check BP on AVF hand No tight clothing Not to carry heavy stuff
Do not allow blood collection from AVF hand in case ,
other than Haemodialysis
Do not insert cannula No blood sample collection
Do not scratch the AVF hand vigioursly
General Care….
By patient: Check fistula daily
Cannulation
Patient counselling before fist cannulation
Encourage patients to wash the AVF hand with soap
and water in dialysis room
Encourage hand washing before cannulation at dialysis unit
AVF Cannulation is a clean hand procedure
Dialysis unit staff needs to follow clean hand
procedure before cannulation
Apply/inject local anaesthesia if required
Use of local anaesthesia is a personal choice, either a
gel or injectable
Post dialysis AVF Care to be explained
Post needle removal care like adhesive/tourniquet
removal and exercise to be explained to the patients
‘Rope ladder’ needling techniques is
preferred for the longevity of AVF
Rope ladder needling sites Semi-circular adhesive - Post HD
Warning Signs….
Bruising and swelling
Aneurysm
Warning signs ….
Warning Signs….
Redness and heat
Warning signs ….
Arterial ‘steal’ syndrome due to reduced blood supply
Warning signs….
Allergies
Wound/infection / shiny skin with pulse on the fistula site
Warning signs ….
Investigations , if required
Fistulagram if there is a reduced flow through AVF
Investigations , if required….
De-clotting of AVF
Emergency care , in case of unexpected bleed
Apply pressure till blood clots Application of Bottle Cap
Thank you for your time !

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Care of AV Fistula (with explanation on download).pptx