Getting Ready for a Fistula or a Graft Placement
Getting a fistula or graft placed is part of getting ready for hemodialysis. A fistula or graft is the
preferred access for dialysis. This list outlines things you need to do to get the dialysis access.
Begin to protect your arm. If you are right handed, your surgeon’s first choice is to place
the access in your left arm. If you are left handed, the right arm will be the surgeon’s first
choice. There are times when this will not be the case. Your surgeon will tell you which arm
to protect. Tell people not to use that arm for IV’s, needle sticks for lab work, or checking a
Ultrasound mapping. Some patients may need studies to check the size of the blood vessels
before the access placement. Ultrasound mapping of the arm is one useful tool to assist the
surgeon in planning for access. There are no needles involved when mapping is done.
Venogram. Some patients may need a study called a venogram. In this study, a needle is
used to inject dye into your blood vessels. The Access Team will decide which study is best
Access Clinic. At this visit, your access options will be discussed with you. The Access
Team will decide the best type of access for you based on your exam and any tests you may
have had. After that, you will go to the Outpatient Surgery Center to discuss anesthesia.
You will NOT have surgery on this day. Your surgery will be scheduled within 30 days of
this visit. You do not need to hold your medicines or insulin, or skip breakfast for this visit.
Surgery. A fistula or graft is placed in the operating room. This will take about 1 to 2
hours. You will be watched after surgery until you are ready to go home (most often in 1-3
hours). You must have a ride to and from the hospital. You cannot drive after getting
medicine for pain. You must also have someone who can stay with you during the first
After surgery teaching. Before you leave, your nurse will give you a handout about how to
take care of your new fistula or graft. It is helpful if your driver can be with you when the
nurse reviews these instructions. You may take your arm out of the sling after you get home.
Prop it on a couple of pillows to decrease swelling when you are sitting in a chair or in bed.
Return to the clinic. You will be scheduled back to the Access Clinic within 3 weeks after
your surgery to have your new access checked.
Call your kidney doctor if you have any of the following symptoms:
ξ Severe pain at or near access site
ξ Swelling with numbness or tingling of access site
ξ Redness, warmth or drainage at the incision site
ξ Fever above 100° F
ξ Bleeding from access site that doesn’t stop after holding firm direct pressure for 20
ξ Pale, purple or cold fingers
You may contact your kidney doctor by calling (608) 270-5656 between the hours of 8-4:30
Monday - Friday. After hours, on weekends or holidays, please call the same number and follow
the answering machine instructions. If you cannot contact the doctor for any reason, go to the
nearest Emergency Department.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©1/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6640.