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Arteriovenous Graft Creation For Hemodialysis

AMBULATORY CARE:

What you need to know about an arteriovenous graft (AVG) creation:

An AVG creation is surgery to connect an artery to a vein using a graft. A graft is an artificial tube. You may need an AVG if your artery and vein cannot be directly joined together for hemodialysis. The AVG is usually placed in your forearm or upper arm.

How to prepare for an AVG creation:

Your surgeon will talk to you about how to prepare for surgery. You may need to stop taking blood thinners 1 week before surgery. Your surgeon may tell you not to eat or drink anything after midnight on the day of your surgery. He will tell you what medicines to take or not take on the day of your surgery. You may be given an antibiotic through your IV to help prevent a bacterial infection. Tell a healthcare provider if you have had an allergic reaction to an antibiotic. Ask someone to drive you home and stay with you after surgery.

What will happen during an AVG creation:

You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given local or regional anesthesia to numb the surgery area. With local or regional anesthesia, you may still feel pressure or pushing during surgery, but you should not feel any pain. Your surgeon will make an incision in your arm. He will connect your artery and vein with the graft. Your incision will be closed with stitches and covered with a bandage.

What will happen after an AVG creation:

  • Healthcare providers will monitor you until you are awake. They will feel the area over your AVG for a thrill, and listen for a bruit. A thrill is a vibration, and a bruit is a humming noise. The presence of a bruit and a thrill mean that blood is moving through your AVG properly. A healthcare provider will show you how to feel for a thrill.
  • Your arm may feel sore for several days after your surgery. You may have mild bruising or swelling near your wound. Your wound may drain a few drops of blood or pink fluid for 24 hours. Your AVG will take 2 to 3 weeks to heal. After this time, it can be used for hemodialysis.

Risks of an AVG creation:

You may bleed more than expected or get an infection. Your AVG may become narrow or blocked. This may stop blood flow through your AVG, or to your arm or hand. You may need surgery to fix this or create another AVG. You may get a blood clot in your arm or leg. This may become life-threatening.

Call 911 for any of the following:

  • You feel lightheaded, short of breath, and have chest pain.
  • You cough up blood.
  • You have trouble breathing.
  • You cannot stop the bleeding from your wound even after you hold firm pressure for 10 minutes.

Seek care immediately if:

  • Blood soaks through your bandage.
  • Your arm, hand, or fingers are cold, numb, blue, or pale.
  • Your bruise suddenly gets bigger.
  • You have trouble moving your arm or hand.
  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

Contact your healthcare provider if:

  • You have a fever or chills.
  • Your wound is red, swollen, or draining pus.
  • You have nausea or are vomiting.
  • Your skin is itchy, swollen, or you have a rash.
  • You cannot feel a thrill over your AVG.
  • You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Care for your wound as directed:

Remove your bandage in 48 hours or as directed. Carefully wash around the wound with soap and water. Dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty.

If bleeding from your wound occurs:

Apply firm, steady pressure to stop the bleeding. Apply pressure with a clean gauze or towel for 5 to 10 minutes. Call 911 if bleeding becomes heavy or does not stop.

Activity guidelines for your arm with the AVF:

  • Do not lift anything heavier than 5 pounds for 48 hours or as directed.
  • Do not push or pull with your arm.
  • Do not sleep with your arm tucked under you.
  • Do not carry a purse or bags with your arm.
  • Do not wear tight-fitting clothing or jewelry over your arm or hand.
  • After 48 hours, do gentle arm exercises as directed. These exercises will help your AVF heal.

Feel for a thrill over your AVG:

Your healthcare provider will tell you how often to feel for a thrill. Place your index finger and second finger over your wound. You should feel a vibration.

Apply ice:

Apply ice on your wound for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel before you apply it to your skin. Ice helps prevent tissue damage and decreases swelling and pain.

Elevate your arm:

Elevate your arm with the AVF above the level of your heart as often as you can. This will help decrease swelling and pain. Prop your arm on pillows or blankets to keep it elevated comfortably.

Tell healthcare providers that you have an AVG.

Tell them not to do IVs, blood draws, and blood pressure readings in your arm with the AVG. Do not get injections in your arm with your AVG. These actions can help prevent infection, bleeding, or damage to your AVG.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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