Arteriovenous Graft Placement For Hemodialysis

WHAT YOU SHOULD KNOW:

An arteriovenous graft (AVG) is surgery to connect an artery to a vein using a graft. A graft is a plastic tube. You need an AVG if your artery and vein cannot be directly joined together for hemodialysis. Hemodialysis is a treatment for kidney failure. It uses a machine that works like your kidneys to clean waste from your blood. The AVG is usually placed on your nondominant arm. If you are right-handed, the AVG will be placed on your left arm. Blood will go out from and come back to the AVG after being cleaned by the hemodialysis machine.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Surgery to make an arteriovenous graft carries certain risks. You may bleed more than expected or get an infection. You could have trouble breathing or get blood clots. You could have an allergic reaction to anesthesia medicine. Your caregivers will watch you closely for these problems. You may have continued pain or swelling after the surgery. Sometimes the surgery may not be successful and needs to be done again. If you do not have surgery, the pain or symptoms you have may get worse. Call or ask your caregiver if you are worried or have more questions about your surgery.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Anesthesia: This medicine is given to make you comfortable. You may not feel discomfort, pressure, or pain. An adult will need to drive you home and should stay with you for 24 hours. Ask your caregiver if you can drive or use machinery within 24 hours. Also ask if and when you can drink alcohol or use over-the-counter medicine. You may not want to make important decisions until 24 hours have passed.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During your surgery:

• You are asked to change into a hospital gown. You are given medicine to help you relax or make you drowsy. You are taken on a stretcher to the operating room. You may be given a local, regional, or general anesthesia to control pain during the surgery. You are placed lying on your back. The whole arm where the AVG will be done is cleaned with a cleansing liquid. Sheets are put over you to keep the area clean.
  
  
• During surgery, an incision is made on the skin, midway between the blood vessels. Special tools are used to separate the vein and the artery from nearby nerves and tissues. Clip-like tools are placed on both blood vessels to stop blood flow. Incisions are made on the blood vessels where the graft (plastic tube) will be attached. One end of the graft is inserted in the artery and the other in the vein. Stitches are used to secure the graft to the blood vessels. The clip-like tools are removed and the blood vessels checked for blood flow. The graft will be positioned close to the skin, and the skin will be closed with stitches. The wound is then covered with a bandage or surgical tape.

After surgery:

You are taken to a room where your heart and breathing will be monitored. Do not get out of bed until your caregiver says it is okay. A bandage may cover wounds to help prevent infection. You may be able to go home after some time passes. If you had general anesthetic, an adult will need to drive you home. Your driver or someone else should stay with you for 24 hours. If you cannot go home, you will be taken to a hospital room.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Medicines: You may be given the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.