Dialysis FAQ for Patients
AV Graft or Fistula Placement
What is an AV Graft (AVG)?
An AV (arteriovenous) graft is a surgically implanted, looped synthetic tube that connects an artery to a vein, usually in the arm. It provides long-term access for hemodialysis when natural veins are too small or blocked for an AV fistula. This creates a high-flow pathway for blood to be filtered by the dialysis machine, though grafts are more prone to clotting and infection than fistulas.
What is an AV Fistula (AVF)?
An AV (arteriovenous) fistula is a surgically created connection between an artery and a vein, typically in the arm. This allows the vein to enlarge and strengthen over time, making it suitable for dialysis needles. Because it uses the patient’s own blood vessels, a fistula is less likely to clot or become infected than other access methods.
Normal Findings After Surgery
Keep your regular scheduled appointments if you experience any of the following:
• Mild drainage during the first 2–3 days after surgery. A small amount of bloody, clear, or brownish drainage is normal as long as it does not soak the bandage within 2 hours and is not foul-smelling.
• The area around the incision may feel raised, firm, and red immediately surrounding the site. Redness should not extend more than two inches beyond the incision.
• Numbness around the incision or hand numbness can occur and usually resolves on its own. Move your hand often and use a squeeze ball.
• Constipation is common after surgery. Stay hydrated, walk regularly, use Miralax if needed, and limit narcotic pain medications.
• Stable pain that is not suddenly worse than at discharge.
• Mild swelling of the affected arm after AV graft or fistula placement. Elevate the arm above heart level as much as possible.
Abnormal Findings After Surgery
Contact the office or your dialysis unit immediately if you experience any of the following:
• Significant increase in pain with a cold extremity or the hand appearing pale, dusky, or bluish-gray.
• New or sudden inability to move fingers or the hand on the affected side.
• Opening of the incision with significant bleeding or drainage that saturates the dressing within 2 hours, or drainage with foul odor and increased pain.
• Significant or worsening swelling that does not improve with overnight elevation.
• Increasing redness spreading more than two inches beyond the incision with increased pain.
• Fever over 101°F.
What is a Fistulogram?
A fistulogram is a specialized X-ray procedure using contrast dye to evaluate blood flow in an AV fistula or graft. It helps identify narrowing or blockages and can guide treatments such as balloon angioplasty or stent placement. After the procedure, you will have a small stitch that dissolves within a few days.
What is a Declot?
A declot procedure removes blood clots from a blocked dialysis access to restore blood flow. This minimally invasive procedure may use mechanical tools, clot-dissolving medication, and balloon angioplasty or stents to treat underlying narrowing. After the procedure, a small stitch will dissolve within a few days.
Clots prevent effective dialysis by blocking blood flow through the fistula or graft.
What is a Permacath (Permcath)?
A Permacath is a tunneled dialysis catheter placed in a large vein, usually in the neck or chest. It has two internal tubes that allow blood to be removed and returned during dialysis without needles. It is tunneled under the skin to reduce infection risk and is often used temporarily.
When is it used?
• When urgent dialysis is needed.
• When blood vessels are not suitable for a fistula or graft.
• While waiting for a fistula or graft to mature.