AV GRAFT

How is this procedure performed?

Follow your doctor’s orders to prepare for this surgery. Those who are right-handed will often have the left arm chosen for surgery — the right arm for those who are left-handed. If a blood test is ordered before surgery, always ask to have the blood drawn from the arm that will not be operated on.

In the operating room your arm will be swabbed with antiseptic solution and numbed with a small shot so you will feel no discomfort. You may receive additional medicine to relax you and make you feel drowsy. Antibiotics are given to lessen the chance of infection. In most cases, the entire operation will take about 90 minutes.

When the AV graft is implanted, two small incisions are made (AV grafts are commonly placed in the forearm, but they can also be placed in the upper arm or the thigh if necessary). A tunnel is made under the skin to aid in the placement of the graft. One end of the graft is sewn to the artery and the other to the vein. Blood will then flow rapidly from the artery through the graft into the vein.

What are the risks?

There is a risk of infection with any operation. If infection occurs, it can sometimes be treated successfully with antibiotics. However, the graft may have to be removed and another inserted in a different location. If this happens you may also need to have a temporary catheter placed in the area of the neck or groin.

If too much blood flows through the graft and not enough flows to the hand; pain, coldness and numbness may result. This may require reoperation to restrict blood flow through the graft so that more blood flows to the hand.

What is the recovery like from surgery?

You will experience some bruising, swelling and discomfort in your arm. This is normal and pain medication may be prescribed. Your doctor will give you specific advice, but in general these steps should be followed after you are released from the hospital:

  • Keep the arm extended and elevated above the level of the heart; place it on a pillow while lying down and hold it up while sitting.
  • Keep the incision area clean and dry; change and replace wet or soiled dressings.
  • Avoid putting any pressure on the arm or swinging it around.
  • Rest, follow your diet, and take your prescription medicines.
  • Your doctor may advise you to perform specific exercises.

When can the graft be used?

After the swelling has gone down, you will be able to see the faint outline of the graft in your arm. By placing your fingertips over the graft you will be able to feel a vibration (thrill) that indicates blood is flowing. When you return for your check-up, ask to use your doctor’s stethoscope to listen for the swishing noise (bruit) the blood makes as it flows through the graft. These two signs indicate the AV graft is functioning as intended.

What should I expect during a haemodialysis session?

The first step is to make sure the area where the needle will enter the skin is disinfected. The dialysis technician should wash the site with soap and water, then rub a special antiseptic solution in a circular motion over the area selected. Once this has been done, do not touch the area until after dialysis is complete. Remember that the needle breaks the skin, opening a door for infectious bacteria to enter. Absolute cleanliness is required to reduce your chances of infection.

The technician will then insert the needles through the skin and into the graft or fistula. The needles are taped in place and connected to the lines of the dialysis machine and the dialysis process begins.

When your blood has been sufficiently cleansed of waste products, the technician will remove the needles. To stop the bleeding, the technician may ask you to hold light pressure with a sterile pad. Use just enough pressure to stop the bleeding — too much force may slow the blood flow through the graft or vein and lead to problems.

How long do grafts stay open?

On average, grafts stay open about a year. It is difficult to predict because some grafts become blocked after only a few months while others may stay open for years. You will know when the graft is blocked because the swishing noise and vibration (bruit and thrill) stop. Blockage usually occurs because scar tissue forms where the graft is connected to the vein. This slows the blood flow and produces a clot. When this happens, it is not dangerous, but it does require another trip to the operating room where the scar tissue and clot are removed and the graft is repaired.

When the graft is new there may be bleeding into the tissue surrounding the graft after the needle is removed. The chance of this occurring will diminish as your body heals around and into the graft. During your first visits to the dialysis center, the staff will watch closely for any signs of bleeding under the skin. After the initial phase of your treatment, your dialysis sessions should become more routine. If you have an AV graft, it is a good idea to make a diagram at the end of every dialysis session showing where the needle entered the graft. You should allow that spot to heal before it is punctured again. On your next visit, remind the technician to insert the needle at least one-half inch away from the previous puncture. It is best to have future needle punctures proceed along the full length of the graft before returning to any previous site. This allows the body enough time to repair the graft puncture.

On average, grafts stay open about a year. It is difficult to predict because some grafts become blocked after only a few months while others may stay open for years. You will know when the graft is blocked because the swishing noise and vibration (bruit and thrill) stop. Blockage usually occurs because scar tissue forms where the graft is connected to the vein. This slows the blood flow and produces a clot. When this happens, it is not dangerous, but it does require another trip to the operating room where the scar tissue and clot are removed and the graft is repaired.