AV Fistula

12 Oct

dia7_dial_fistula.jpg

Look at this picture here at OverMyMedBody–This is a picture of an aneurysmal arteriovenous fistula. A snake in the arm or camel humps.

To create these fistulas which is the most preferred access for hemodialysis a surgeon will attach an artery and a vein together. By doing this the capillaries are avoided and the blood flows from artery to vein rapidly. The turbulence causes a vibration known as a thrill. 

I will never forget the first time I accidentally felt a thrill for the first time.  I was participating in an externship for the summer right before my last semester of nursing school. (I did not want to go back to school after that). I gently rested my hand on the patients forearm.  I felt a cat purring. I doubled checked and yes: it was an arm…no cat.  I saw the sign above the bed that read: no blood pressure left arm. I am startled. Everything is intact. I see 2 camel humps on this patients arm and they are purring! Vibrating! Pulsating! I felt sick!

I go to my papers. I took report surely there must be something on my paper about this freaky pulsating vibrating, purring camel hump arm. There it was in my own hand writing. Brachiocephalic fistula, +bruit, +thrill: Hemodialyis M-W-F.

I just did not know what it was or what it meant! I was figuring it was access for HD that did not really concern me. Well..it surely did concern me. I nearly lost my skin color feeling that thrill. It was Buzzing.

The complications of AV fistulas are somewhat less as compared to sepsis from a central venous catheter and clotting associated with grafts. One of the complications of fistulas are aneurysms–the vessel wall gets weak from needle sticking as can be seen by the link above!

fistula.jpg

Anyway I will not forget that first thrill, that frightened me so much!

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19 Responses to “AV Fistula”

  1. Jlee August 19, 2009 at 17:21 #

    Thanks for posting this description of the underlying anatomy. I’m a massage therapist and had a new client last night with an AV fistula and had never seen one before!

    • seejanenurse August 26, 2009 at 18:23 #

      Ha it can be strange the first time! I hope you didn’t massage it!!!

  2. stevie elder December 4, 2009 at 20:57 #

    yesterday I had fistula surgery on my left arm.2day it feels like I’ve been gunshot.I want to see a pic of what my arm will look like in a year from now.I suppose I’m through w/tank tops,but, if it’ll save my life… I’m in end stage renal failure + dialisys bound.

    • seejanenurse December 6, 2009 at 03:04 #

      Hi. Hope it feels better soon. I have a huge interest in nephrology nursing and would love to hear about your experiences from your point of view, so please come back or send me an email. Do you write about it?

      There are tons of pictures and I have seen and felt many fistulas in my path so keep me updated please!

      seejanenurse@hotmail.com

  3. stevie elder December 6, 2009 at 18:47 #

    Well ,this is day three+ I’m pleased to say it feels much better.In fact I won’t need any pain meds 2day.YIPPIE. I took the dressing off + the incision is alot smaller than I thought.another YIPPIE.It feels like there’s a tiny fuel pump under my skin+ I can almost hear it.Trippy!Anyway,thanks for responding to my post.It’s realy nice to have someone else besides my old man to talk to about this.I think he’s sick of listening to my thoughts + fears. PEACE-OUT

    • seejanenurse December 7, 2009 at 14:38 #

      that sounds good, hope day four is even better. yeah it kind of purrs like a kitty cat? i am always listening anytime. ❤

  4. Sandra H. March 1, 2010 at 03:08 #

    I am a vascular technician and I loved your illustration. It is important to understand fistulas because vascular techs evaulate fistulas to ensure that it is open and not closed off. Thank you so much for your beautiful illustration. My hats off to you!

  5. COURTNEY October 20, 2010 at 22:47 #

    hey stevie, just happened upon this site and saw your comment. i feel for ya. had my fistula 11/09. had to have 2 surgeries on my arm. it kinda looks better now. been in dialysis since 2/10. on transplant list, just waiting now. anyway take care, good luck!!!

  6. Massage October 23, 2010 at 09:42 #

    Thanks for posting this description of the underlying anatomy

  7. NLP Techniques : October 29, 2010 at 18:53 #

    my father is a massage therapist and this is a good paying job to and the job is easy ~

  8. Marco Suarez November 1, 2010 at 00:47 #

    I found your article very interesting. I’m sure it must have been funny for you to feel the thrill for the first time, did you happen to listen for the bruit with your stethoscope? That is an incredible sound to hear coming from a patient.

    I am a pre-med student with a Brachiocephalic fistula in my left arm. I had it placed about a year and a half ago. I will be the first to tell you that it’s an omnipresent feeling, especially when going to bed.

    Since it was put it, my fistula has nearly doubled in diameter due to my age and lifestyle, so this makes the bruit and thrill even stronger.

    I’m glad to hear you are going into renal nursing, it is an honorable field and requires lots of special care for patients.

    I wish you the best of luck,
    Marco

  9. rylo August 19, 2011 at 17:21 #

    When my 2 year old son touches my fistula and feels the thrill, I tell him I’m a robot. I had to quit playing baseball after 20 years when I got my fistula because a ball hitting it could cause too much damage. I was 26….

    • seejanenurse August 28, 2011 at 01:24 #

      awwa- sorry about the baseball loss. the robot idea is so creative. 26 is so young to experience this chronic condition. my heart is with you and your family. ❤

  10. sam February 14, 2012 at 14:18 #

    Jane,
    Nice explanation, just i have a quick question.
    Is this reversible? I mean once patient is fine, and no more dialysis can this be made as it was before? and how is tat handled?

  11. Brit Squaddie October 5, 2012 at 14:22 #

    I tell anyone who touches my fistula that I have been bitten by an Electric Eel. The look on some peoples faces. They ask me what it was like and I just say “It was absolutely shocking”. Its called putting the word “fun” into dialysis.

  12. Robin Nowland December 11, 2013 at 19:33 #

    a question, I have just had a fistula placed in my left arm. Will there be a graft for accesss or does one get stuck with needles everytime dialysis is required?

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