Although the bruit is usually heard with a stethoscope, it also can be felt on the overlying skin as a vibration, also referred to as a thrill. If you do not feel the thrill or hear the bruit in your access, call your doctor or the dialysis center immediately.
Use sound and touch to check the blood flow through your fistula daily. When you place your ear or fingers over your fistula, you should be able to hear a consistent swoosh or feel a slight vibration.
The sound you hear may change from a swooshing noise to a whistle-like sound. Any change in the pitch may indicate a clot or a narrowing of the fistula. The changes will be more significant in cases with more narrowing. Changes in the fistula bruit may signal a serious issue with your dialysis fistula, so be sure to monitor it daily and report any changes to your doctor as soon as you notice them. Over time, blockages in the vein may reduce blood drainage or the flow of blood from your artery into the fistula, or your fistula may become fully blocked with blood clots.
There are three ways to place them—two good, and one bad. It is best to rotate sites for each treatment and move all the way up and down the top and sides of a fistula or graft.
This makes a pattern that looks a bit like a rope ladder. Tracks form, like pierced earring holes, and guide the needles to the right place. This approach can cause less pain and fewer bumps on a fistula. But, there is a higher risk of blood infection if the scabs from the last treatment are not removed in a sterile way.
Placing needles into the same small area over and over will cause weak spots in a fistula or graft. These can bulge out and form large bumps. If the weak spots rupture, death can occur.
Know your access and where the needles should go. Learn to put in your own needles to protect your lifeline. HD needles go through your skin and into the top wall of your access. But, if a needle keeps going through the bottom wall of your access, blood will leak out into your arm. This is an infiltration and it can cause painful bruising that takes days—or weeks—to heal. An infiltration can harm your access. If this happens, your treatment may stop.
A nurse or tech may put pressure on the site and put in a new needle. Use of a cold pack 15 minutes on, 15 minutes off can help limit the size of the bleed. After 24 hours, a warm pack 15 minutes on and 15 minutes off can help your body absorb the blood. You are the only one who can feel both ends of the needle. So, you are the least likely to infiltrate your own needles if you learn how to put them in. No one likes needles, but some fear them so much that they avoid health care they need.
Or, they are anxious before each HD treatment. Needle fear can make you feel dizzy or faint. Your heart may race. You might even pass out.
This is not your fault—and there are ways to help. Or, learn how to put in your own HD needles! This is self-cannulation. YOU are the only one who can feel both ends of the needle, so you have the best chance of protecting your lifeline.
When you focus on doing it right, it hurts less, too. Learn more about needle fear and how to cope with it. A fistula or graft can help you live longer on HD. But, if people see it, they may ask you about it.
But, a fistula or a graft can show, and this is something you will need to get used to. Besides a scar on your arm, a fistula is a large vein. This is normal and a sign of a good, healthy lifeline. But, people may see it and ask about it. The needle marks can show, too. And, it can take you time to get used to the buzzing of a healthy access. A graft is not as large, but can show as a large line or loop under your skin.
Some people wear long sleeves all year to hide a fistula or graft. Others choose to look at their access as a battle scar of a war they are winning with kidney failure. After all, we all have scars. Some use questions about their access as a chance to teach others.
If you expect questions and think of answers, it may help you to cope with the change in your body when it occurs.
It is normal to be sad about changes to your body. And, it can help you to talk about your feelings. Your fellow dialysis warriors know what you are going through. Your clinic social worker is a resource, too. Stenosis can often be fixed.
A vascular surgeon can open up the access and put in a stent a sort of splint to keep it open. Needles cannot be placed into a stent.
Too many stents may mean it is time for a new access. If you need HD right now , you will need an HD catheter. Or, if you have a fistula or graft that needs repair, you will need one. Anyone on HD may need a catheter at some point.
An HD catheter takes 15 to 30 minutes to place. This can be done using an ultrasound machine or by injecting contrast dye into your veins while under fluoroscopy a type of x-ray so an image, or map of your veins, can be obtained and evaluated. After surgery, you may experience some pain, swelling and bruising near your access site for a few days. This is normal. You may also notice a vibration coming from your access site.
In fact, over the first week following your surgery, this thrill will strengthen. Before your AV fistula can be used, it needs time to mature. An arteriovenous fistula requires daily inspection and care.
You need to look, listen and feel for signs that your AV fistula is functioning properly. Look — Look at your access to check for signs of infection — swelling, redness, warmth and drainage are all signs to watch for.
Also note if there are any changes to the skin, such as bleeding, bulging or peeling. Listen — Put your ear to your arm or leg and listen for the sound of blood flowing through your fistula.
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