Vascular access for hemodialysis: Caring for your child after the procedure

Your child has had a procedure to improve vascular access for hemodialysis. This brochure explains how to care for your child at home after the procedure, and when to call for help.

When can my child go home?

• Your child can go home on the same day as the surgery.

Possible complications of AV fistula and AV graft

Two major complications are possible:

• infection
• thrombosis (clotting of fistula or graft)

Signs of infection

• warm painful area over your child's access site
• redness and swelling over your child's access site
• fever of more than 38.0°C (100.4°F)

Signs of thrombosis

• no "bruit" or sound over your child's access site
• painful, hard welling over your child's access site

Taking care of your child's vascular access

• After surgery, your child will have a bandage on their arm. Keep it dry for 48 hours after the surgery.
• After 48 hours, remove the bandage and wash the area with mild soap and water. Gently pat this area dry with a towel. If there are small pieces of white tape under the bandage, leave them in place for one week or until they fall off.
• After the bandage is removed, the incision may ooze clear fluid. If this happens, cover the incision with clean, dry gauze. Change the gauze every day.
• Your child's surgeon may use Steri-Strips, staples or dissolvable sutures (stitches) to close your child's incision.

Steri-Strips, staples or sutures

Steri-Strips

Leave Steri-Strips on until they fall off on their own. This usually this happens four to seven days after the surgery.

Staples

Staples can be taken out 10 to 14 days after the surgery.

Dissolvable sutures

Leave dissolvable sutures alone. They will dissolve on their own within 10 days.

Caring for your child's fistula or graft

DO:

• Keep the line of stitches on your child's fistula or graft clean and dry until the wound edges have sealed (approx. 48 hrs.).
• Notify your child's doctor or dialysis unit immediately if the fistula or graft is red, tender or painful.
• Encourage your child to drink fluids within their fluid allowance (to prevent dehydration).
• Encourage your child to keep their arm up when resting to reduce swelling. This can be done by placing your child's arm on a pillow at the same level as their heart.
• notify your child's doctor immediately if the access site bulges more than usual or your child experiences low blood pressure, dizziness or lightheadedness.
• listen for the "bruit" or feel for the "thrill" in your child's fistula or graft four times a day (first thing in the morning and the last thing at night).

DON'T:

• allow your child's arm with the fistula or graft to be injured.
• allow your child's blood pressure to be taken on that arm.
• allow blood to be taken from that arm
• allow an intravenous line to be started in that arm.
• allow your child to carry heavy items using that arm.
• allow your child to sleep on that arm.
• allow your child to wear a watch or bracelet on that arm.
• allow your child to wear tight sleeves.
• allow your child to pick any scab formations on that arm.

When to seek help

Call the hospital immediately if you think your child is suffering from an infection or thrombosis.

Nephrologist (on call): (416) 813-7500

Hemodialysis unit: (416) 813-7653

After hours:

Go to the nearest Emergency Department.

At SickKids

Pain Medication

Before you leave, we will give your child a prescription for _____________________________. If your child has an allergy to this medication, we will provide them with a different prescription. Most people need medication for only a few days.

Other Medications

If your child stopped taking their blood thinning medication before the surgery, please speak to a doctor about restarting this medication before leaving the hospital.