MyHealth.Alberta.ca Network

Hemodialysis Access Surgery: What to Expect at Home

Your Recovery

Hemodialysis is a way to remove wastes from the blood when your kidneys can no longer do the job. It's not a cure, but it can help you live longer and feel better. It's a life-saving treatment when you have kidney failure. Hemodialysis is often called dialysis. Your doctor created a place (called an access) in your arm for your blood to flow in and out of your body during your dialysis sessions.

Your arm will probably be bruised and swollen. It may hurt. The cut (incision) may bleed. The pain and bleeding will get better over several days. You will probably need only over-the-counter pain medicine. You can reduce swelling by propping up your arm on 1 or 2 pillows and keeping your elbow straight.

You will have stitches. These may dissolve on their own, or your doctor will tell you when to come in to have them removed. You should also be able to return to work in a few days.

You may feel some coolness or numbness in your hand. These feelings usually go away in a few weeks. Your doctor may suggest squeezing a soft object. This will strengthen your access and may make hemodialysis faster and easier.

You should always be able to feel blood rushing through the fistula or graft. It feels like a slight vibration when you put your fingers on the skin over the fistula or graft. This feeling is called a thrill or a pulse.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

Rest when you feel tired. Getting enough sleep will help you recover. Do not lie on or sleep on the arm with the access.
Avoid activities such as washing windows or gardening that put stress on the arm with the access.
You may use your arm, but do not lift anything that weighs more than about 7 kilograms (15 pounds). This may include a child, heavy grocery bags, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
You can shower, but keep the access dry for the first 2 days. Cover the area with a plastic bag to keep it dry.
Do not soak or scrub the incision until it has healed.
Wear an arm guard to protect the area if you play sports or work with your arms.
You may drive when your doctor says it is okay. This is usually in 1 to 2 days.
Most people are able to return to work about 1 or 2 days after surgery.

Diet

Follow an eating plan that is good for your kidneys. A nutritionist or dietitian can help you make a meal plan that is right for you. You may need to limit protein, salt, fluids, and certain foods.

Medicines

Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
Take pain medicines exactly as directed.
- If the doctor gave you a prescription medicine for pain, take it as prescribed.
- If you are not taking a prescription pain medicine, ask your doctor if you can take acetaminophen (Tylenol). Do not take ibuprofen (Advil, Motrin) or naproxen (Aleve), or similar medicines, unless your doctor tells you to. They may make chronic kidney disease worse.
- Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
If you think your pain medicine is making you sick to your stomach:
- Take your medicine after meals (unless your doctor has told you not to).
- Ask your doctor for a different pain medicine.
If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

Keep the area dry for 2 days. After 2 days, wash the area with soap and water every day, and always before dialysis.
Do not soak or scrub the incision until it has healed.
If you have a bandage, change it every day or as your doctor recommends. Your doctor will tell you when you can remove it.

Exercise

Squeeze a soft ball or other object as your doctor tells you. This will help blood flow through the access and help prevent blood clots.

Elevation

Prop up the sore arm on a pillow anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.

Other instructions

Every day, check your access for a pulse or thrill in the fistula or graft area. A thrill is a vibration. To feel a pulse or thrill, place the first two fingers of your hand over the access.
Do not bump your arm.
Do not wear tight clothing, jewellery, or anything else that may squeeze the access.
Use your other arm to have blood drawn or blood pressure taken.
Do not put cream or lotion on or near the access.
Make sure all doctors you deal with know that you have a vascular access.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You passed out (lost consciousness).
You have chest pain, are short of breath, or cough up blood.

Call your doctor or nurse advice line now or seek immediate medical care if:

Your hand or arm is cold or dark-coloured.
You have no pulse in your access.
You have nausea or you vomit for more than four hours.
You have pain that does not get better after you take pain medicine.
You have loose stitches, or your incision comes open.
You are bleeding from the incision.
You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
You have signs of a blood clot in your leg (called a deep vein thrombosis), such as:
- Pain in your calf, back of the knee, thigh, or groin.
- Redness or swelling in your leg.

Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if you have any problems.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter P616 in the search box to learn more about "Hemodialysis Access Surgery: What to Expect at Home".

Care instructions adapted under license by your healthcare professional. If you have questions about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.