Αρτηριοφλεβική επικοινωνία με μόσχευμα

Information for patients from the Kent Kidney Care Dialysis  Access Team
This leaflet will explain what an arteriovenous graft is, how it is inserted and used.

Why am I having a graft inserted?

You are having a graft inserted to allow adequate access to your blood for haemodialysis. Grafts are used when a person’s blood vessels are too small and fragile to be used for a fistula. Grafts have a reduced infection and complication risk compared with central lines.

What is an arteriovenous graft?

A piece of material is surgically joined to an artery and a vein under the skin. This is usually in the upper arm but may be in the upper thigh.
An arteriovenous graft can also be known as an AV graft or AVG for short.

How will I be assessed to plan a graft?

You will be given a clinic appointment to see a vascular surgeon and access nurse in renal outpatients at Kent and Canterbury hospital. Usually, you will have an ultrasound scan of both arms before you see the surgeon. Once the surgeon has identified which arm is best to have the graft we advise that you do not have any procedures on that arm.
Do not use your arm for blood pressure, injections or infusions. In future this arm will be used for dialysis only.
A date for the surgery will be agreed with you.

How is a graft inserted?

A  graft is inserted in a surgical procedure by a vascular surgeon in an operating theatre.

Will the operation hurt?

The majority of graft procedures are done under general anaesthetic or by an anaesthetic that makes the full arm numb.
You may experience some discomfort for a few days afterwards, you will be advised regarding pain relief.

How long will I have to stay in hospital?

Please refer to your surgery appointment letter. Sometimes the graft is completed as a day case. Allow six to eight hours for complete visit. The procedure normally takes approximately an hour. If you are well enough, you will be able to go home several hours after surgery. If you have had a general anaesthetic you may have to stay overnight.

What will happen when I arrive at hospital?

On admission you will report to either Marlowe Ward and be seen by the access nurse and surgeon who will fully explain your procedure and ask you to sign a consent form. This is the time to ask any final questions.
Before having your operation you will need to put on a theatre gown for the duration of the procedure; you may want to bring a dressing gown with you.
Your appointment letter will tell you if you need to fast before your operation and if you can take your normal medication. It will also tell you if you need to bring an overnight bag in case you have to stay.
You may want to bring something to read and a snack for after the surgery.

What will happen after the operation?

Before you go home the access nurse or renal nurse will see you. You will be advised on the care of your graft and shown how to check it is working. A follow-up appointment will be given to you. Please ask if you have any questions.

When can I drive again?

We advise no driving for several days after the surgery.

What to do if my graft bleeds?

If your graft bleeds after you get home, sit down and apply pressure with clean gauze for 10 minutes. If the bleeding does not stop after this time, please contact your renal unit for advice.
Heavy bleeding from a graft is very rare however should this start to happen, lie on the ground and apply direct pressure over the scar where your graft was inserted. This will compress the artery and stop the bleeding.
If this does not stop-call 999 to be taken to your nearest hospital.

How long will the wounds take to heal?

The wounds will take 10 to 14 days to heal.
We advise that the dressing stay dry for at least three days before being changed. You will be provided with several spare dressings.
Keep the wounds covered for at least seven days, when you will be seen at one week check-up.
Avoid any heavy lifting/pressure with graft arm for two weeks.
Do not keep the graft arm bent for long periods.
We will advise if stitches/clips need to be removed, sometimes the sutures are dissolvable.

When can I resume work?

Please ask your nurse or doctor for advice; this will depend on your type of work.

How can I check my graft is working?

Remember your graft is your lifeline for dialysis and you must know how to look after it when you are at home.

Thrill is a vibrational feeling when you place your fingers on the skin over the graft.
Bruit is the “shoosh-shoosh” noise your graft makes when you listen through a stethoscope.
Twice a day is how often you should check your graft during the day.

Sometimes the hand or fingers may swell after the operation. This is normal. It can be relieved by elevating the arm when resting and avoid wearing rings, elasticated sleeves or wristbands. If the swelling continues or you are worried your graft is not working please call us for advice. The numbers are at the end of this leaflet.

How do I look after my graft at home?

You play an important part in keeping your graft healthy:

Do not take blood pressure measurements from your graft arm
Do not have any blood tests taken from your graft arm
No needles or infusions to go in your graft arm
Do not wear any tight or restrictive clothing on your graft arm
Avoid sleeping on your graft arm
Do not use sharp objects near your graft arm, such as razors.
Avoid carrying heavy loads or shopping bags directly over your graft arm
Do not remove the scabs from the needle sites as this may introduce infection or cause bleeding

Please note in an emergency these guidelines may not apply. You should be guided by the medical staff in attendance.

What complications may occur?

Infection is a risk with a graft. If you develop pain, redness or the skin around your graft becomes hot please tell a nurse or doctor. You may require an antibiotic if an infection is present
Thrombosis (a blood clot) may be a common cause of graft failure but this type of clot is not life threatening.
Arterial Steal Syndrome is caused by the graft diverting too much blood into the vein. The hand then does not receive enough of a blood supply. The signs and symptoms of steal syndrome are coldness in the hand/fingers. This will be monitored.

If you have any concerns please call your dialysis unit if you are on dialysis or contact the Renal Access Nurse (see telephone number below)

When is a graft to use?

Some grafts can be used the day after surgery while others can be used two weeks after insertion. We will provide a soft ball for you to squeeze which will help improve the blood flow through the graft.

How is a graft used for dialysis?

The graft is used for haemodialysis by placing two needles at different places along the graft. The needles have special tubing attachments, the blood will flow through the first needle out of the body, through the dialysis machine to clean the blood and back through the second needle into the body.

You will not be able to use the buttonhole needling technique with a graft.

How long will my graft last?

There is no definite answer to this question, grafts can fail at any stage if you become ill or suffer an episode of low blood pressure. Other reasons can be direct trauma to your graft, infection or if something alters how your blood clots. However the majority of grafts work immediately following surgery. You should remember that a successful graft has a higher risk of infection and clotting than a fistula but lower risk than a central line. You may expect the graft t last on average two or three years and you may need procedures in the future to keep the graft patent.