Preparing for Fistula

[BennettBella]

I am a newbie to this site, and recently entered stage 5 kidney disease. I went from a GFR of 26 to 7 in 6 months. I am scheduled to have a 2-stage surgery to move a being close to an artery, to prepare for a fistula in just a few days. The reason for a two stage procedure? I have small veins, and only one was found, verified by ultrasound mapping of both arms, that will support a fistula. The second procedure will allow dialysis, but the 2 stage procedure increases time without benefit of dialysis. Due to the GFR and my symptoms (increasingly worse) my NEW nephrologist has indicated the possible need for a port/pic line as a very short term access (due to high infection risks) if absolutely necessary, allowing time for the fistula to mature. Has anyone had this experience, and is there any information you can share? Any advice is appreciated.

[cs65 NKF Ambassador]

Yes, this can happen when a fistula is created. It does take time for it to mature and be able to be used for dialysis, typically several months. You can help this maturation process by squeezing a rubber ball with your fistula hand to exercise that arm. When I got my fistula no one told me to exercise my arm, so I had to have a second procedure, a balloon angioplasty, to make the fistula large enough to use. Then they were able to use my fistula. You will probably have to have a port installed so you can start dialysis sooner. Both procedures are done under sedation, so you won't feel any pain. I am sensitive to pain medications, so I ask for iv sedation without too much painkillers and I also request zofran to prevent nausea. I've had several balloon angioplasties and haven't suffered any side effects since I was educated how to manage them by anesthesiologists. Also, don't drink too much juice right after a procedure! You should do just fine - good luck!

[mingmiley in reply to cs65]

Hi, Cs65, How are you, talk about sedation, I have a question to ask. One time when I going through the fistula angioplastic the nurse told me the side effect of the sedation is memory loss, so I was afraid of becoming dimentia, so after that every time i had to do a angioplastic I told them not to use sedation. The first three times angioplastics the pain not bad but the last two times more pain, i don't know if because I became little older or i think the surgeon went in deeper than the previous times too, I had angioplastic about ten times during the last five years, I'm on dialysis 10 years now.

[cs65 NKF Ambassador in reply to mingmiley]

I had an angioplasty once without sedation because I was still recovering from having cardiomyopathy and my cardiologist said that was the only way I could have the surgery. the only pain I felt was when the surgeon put the local anesthetic needle into my arm. After that I only felt pressure, so I guess you could do it that way. I've had several angioplasties and I don't feel like I've had memory loss, just felt tired afterward and took a nap. I wouldn't recommend doing it without sedation, particularly if it was a complicated procedure like the one I had when my whole fistula clotted up and I needed lots of clot buster. I did hear the surgeon during at least that one when I just had local anesthesia. Mostly the sedation just makes you feel like you don't care what's going on, in a good way!

[mingmiley in reply to cs65]

Thanks for your reply and your experience.

[PracBob]

I have had a central line twice for many months at a time without any problems. I'm very careful. I only did sponge baths to keep clean.