Hello! I had my first surgery for a fistula yesterday. Surgeon connected my brachial artery to my basilic vein at the elbow. I had a nerve block in my arm that they told me would last for 18 to 24 hours and it was already starting to wear off while I was in recovery. A few hours later and it was almost completely worn off. The nurse said they didn’t give me enough of the nerve block. When I was discharged they didn’t tell me anything except to try not to bend my arm and I can take the dressing off tomorrow . I had to ask about exercising the arm with a soft ball. She didn’t know anything about that. So my question to those that have a fistula, (1) when should I start to do the exercises - how soon after the surgery? (2) how many times should I squeeze the ball per exercise? (3) how often should I exercise it each day? Is there anything else I should be doing? I asked the nurse to show me how to feel for the thrill and she wasn’t sure. Three nurses came in and tried and didn’t feel it. They said it’s probably too deep. I cannot feel any thrill anywhere around the incision. Does anyone know where I should check for it? Should I be feeling it this soon? The instructions they gave me at discharge are useless and even contain some incorrect information. The bruising has spread quite a bit since yesterday. Is this normal? Any other tips or advice would be greatly appreciated. Thank you.
Need advice about fistula please: Hello! I... - Kidney Disease
Need advice about fistula please
Wow, they did not tell you anything...what a shame. So you won't feel the trill right away. I did not feel it for about a week. And then it was faint. There is swelling and inflammation right now that may be blocking it. Give it some time. Do not lift anything with that arm for at least a week or more and then be careful. Ice it if the bruising is still bad. They should have told you that. Then I started using heat at night while watching TV and that felt better. Try to rest the arm for a couple of days. Do not use it much for weight baring, like getting out of bed or out of a chair. I started exercising it after a week with a sponge ball. They thought my fistula was ready in four months and it really wasn't so do not rush it if you can.
Thanks so much for all the good information Bassetmommer. I feel much better knowing it’s normal not to feel the thrill right away. I am trying to keep my arm straight, but keep inadvertently bending it. Do you know if it is okay if it bends as long as I am not putting any weight on it?
Yes, you need to keep things flexible so bending is good. Take care
I was never told to exercise to develop my fistula. I could not feel the thrill right away either. I too have an upper arm fistula. Originally they thought I'd need a second surgery to elevate the fistula, but it floated up on its own, no second surgery needed. My eGFR improved so I haven't used my now two year old fistula. It has matured quite a bit and is very visible in my arm. Quite ugly.
When you feel the thrill now, is it really noticeable? I don’t even know where on my arm I’m supposed to feel for the thrill. I still don’t feel anything in the entire area. My arm is numb from my elbow down to my wrist.
Oh yeah! I even try to freak out friends by asking them to feel my arm! It's a great party trick!
I first felt my fistula the day after surg, and I was exercising ASAP (two days). Dialysis didn't come along for nearly exactly one year later.
I’m sorry because that is flat out wrong for them not to tell you. Exercise means more blood flow to that area which is what they want.
Bruising is very normal. They didn’t warn me and suddenly on day 4 post op, a huge bruise appears on my entire forearm. I went to the ED thinking something was wrong. The thrill will develop more with time.
!!!! Ask your surgeon when it is safe to squeeze the ball!!!! Once it is safe, squeeze as many times as often as you can. Even once you start dialysis, you should still do the squeezing.
I went on amazon and bought a cheap stethoscope to be sure my thrill was there. It will be between your incision and up your arm to your body, where the blood is flowing. The incision is just where the artery and vein were joined. There should be a good 3 or 4 inches along your arm where the thrill is.
Check for the thrill every day. Your fistula is your lifeline. If it clots off, you may have a window of a few days to have a procedure to clear it, otherwise it’s lost!!! Then you will have to have another one surgically put in, and in the meantime have a catheter implanted in your chest for dialysis. Chest catheters have a risk of deadly infection.
If no one bothered to tell you pre-op (no one told ME!), you can NEVER lift more than 10 pounds or you could rupture the fistula and ruin it. Some people insist on lifting more and it’s risky.
Don’t carry anything over your arm around the fistula like a shopping bag which could cut off circulation. No one can take blood pressure or draw blood from your fistula arm!!! They could ruin it.
If your fistula gets cut, you will bleed to death in a matter of less than ten minutes. It will spurt in time to your heartbeat, like any artery that is cut. You will die. You must call 911 right away. Direct pressure or a tournequit might be called for. No one should ever remove a tourniquet EXCEPT the surgeon.
Thank you ShyeLoverDoctor for all the helpful and specific information. I think I can faintly feel the thrill today, day four after my surgery. My arm is still numb from the incision down to my wrist. I’m hoping that wears off before much longer. I think my arm is still slightly swollen although it’s hard to tell. Most of the bruising has faded. I called the vascular surgery dept. and they said I should squeeze the ball 3 different times an hour every hour, so I am doing that. I’ve read that for an upper arm fistula it’s more helpful to do bicep curls. I am going to try doing that with a two pound weight in addition to the ball squeezing.
Day 4 is early. I’m not surprise it’s still numb. Recovery takes a long time and is never a straight line.
It’s numb because there is swelling, most likely. Again, I’m not a doctor! , but guessing it’s the swelling. Could be they severed a nerve. had an operation in January on my forearm. Part of wrist immediately below that and the base of my thumb still numb. They told me, wait a year. My sister in law cut off the tip of her her finger and they told the same thing- one year. A fistula is not repairing anything broken, they’re messing with your anatomy. Still, I wouldn’t call the doctor for a week myself. What can they do after all? But at a week’s time, call your surgeon’s office. That’s what I would do.
had my surgery in March. Had “leakage” as the surgeon described it which resulted in my entire arm swelling and turning purple.
I’ve been squeezing the silly ball since the surgery and the thrill is quite obvious to feel and very interesting to hear. Still holding off on dialysis @ GFR 11 but very obvious I am destined to start soon.
Thanks for sharing! Did they tell you to keep squeezing the ball this long? I already am tired of squeezing the ball because it makes my arm and hand hurt. Day 9 since my surgery and my arm is still swollen, hurts, numb and occasionally tingles from my elbow to my wrist. What is leakage and did it resolve itself?
they didn’t really give me instructions but I thought is best to continue squeezing to keep the thing strong.
The leakage was apparently bleeding from the fistula. I used warm compresses and held it above my head as often as I could.
Wow, that looks like it was painful. Hope it is doing much better now. Best wishes.
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