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.

Getting Ready

The week before your surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  
• Tell your caregiver if you have had previous catheters, procedures, or surgery done on your arms. Your caregiver may also ask you more about your previous diseases or medicines that you are taking.
  
  
• Tell your caregiver if you know or think that you are pregnant.
  
  
• You may need to have blood tests, electrocardiogram (ECG), chest x-ray, and other tests to know how your kidneys are. Ask your caregiver for more information about these tests. Write down the date, time, and location of each test.

The night before your surgery:

• Remove any nail polish.
  
  
• You may be given medicine to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will be asked to change into a hospital gown. You will be given medicine to help you relax or make you drowsy. You will be 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 will be placed lying on your back. The whole arm where the AVG will be done will be cleaned with a cleansing liquid. Sheets will be put over you to keep the area clean.
  
  
• During your surgery, an incision will be made on the skin, midway between the blood vessels. Special tools will be used to separate the vein and the artery from nearby nerves and tissues. Clip-like tools will be placed on both blood vessels to stop the blood flow. Incisions will be made on the blood vessels where the graft (plastic tube) will be attached. One end of the graft will be inserted in the artery and the other in the vein. Stitches will be used to secure the graft to the blood vessels. The clip-like tools will be 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.

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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have a skin infection or an infected wound near the area where the surgery will be done.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• The problems for which you are having surgery get worse.
  
  
• Your blood pressure is higher or lower then what your caregiver has told you it should be.