Fistula Health Education for Patients

Guidelines for Registered Nurses

(Allow approximately five minutes for a personalised
education session with each patient.)

Did you know that in some circumstances fistulas can rupture? Your
fistula is your lifeline and it is important to maintain fistula health. A fistula
rupture is a potentially fatal situation and requires immediate action.

This Fistula Health Education Programme delivers three key messages for patients:

1. Fistula ruptures can happen and they can be fatal!

A fistula rupture (excessive bleeding) is a rare complication (<1%) of haemodialysis. It

can happen at home, in the car, in bed, in the shower or anywhere. Patients need to
learn what to do and make sure the people they spend time with also know what to do.
It could save their life.

2. Be fistula fussy! The warning signs of a potential fistula rupture:

Red, shiny, painful, or swollen areas;

Blisters, large scabs, small black scabs;

Prolonged bleeding or oozing;

Expanding fistula over a short period of time; and

History of fistula access complications (particularly within the previous six months)

How do you maintain a healthy fistula and avoid a fistula rupture?

Encourage patients to hold their own cannulation sites post dialysis. This will help
them to become familiar with their fistula.

They must feel for the thrill (buzzing feeling) daily. If it is missing or faint, they must
report immediately to their local emergency department.

No BP on their fistula arm.

Continue to be scrupulous with hygiene (wash fistula on entry to dialysis unit).

Dress and sterilise any cuts/scrapes near fistula, an infection may start near the
access site. If left untreated, infection may burrow down into the fistula and eat into
the fistula wall creating a hidden fatal point of weakness.

Do not pick or dislodge scabs near or on your fistula.

Avoid trauma to fistula, eg pruning the roses, lifting heavy objects with their fistula
arm.

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What do you do if you think your fistula is in danger of rupturing?

Report to your Clinic Manager or designee immediately, who may arrange for you to
see your nephrologist, vascular access nurse or vascular surgeon. (Not to act or to
make an appointment with their GP could be wasting precious time.) If you are
concerned about your fistula, tell somebody about it. Dont take no for an answer.
You may need antibiotic treatment or you may need surgical intervention.

3. What to do if your fistula does rupture?

Dont panic!
If people have been educated about what to do, they MAY panic less.

Press with your finger

Don not be concerned at this point about infection caused by using a bare finger to
stop the bleeding. Infections can be treated in many cases. Bleeding to death can
not. (Obviously in a clinical situation, nurses would wear appropriate PPE). Do not
remove pressure until medical help arrives. Do not try to stop a large blood flow
with towels or gauze. These items will act like a candlewick and only soak up blood.
It also makes it difficult to pinpoint the exact point of rupture.

According to vascular surgeons and emergency doctors, the use of tourniquets is

controversial due to the possibility of severely damaging tissue. Also, several
autopsy reports have shown, patients have been found dead with tourniquets found
next to them on the floor. They have most probably been trying to locate the
tourniquet and then maybe not had enough time to apply it before showing signs of
severe blood loss.

Lift your arm above your head whilst still applying pressure
Gravity will reduce the blood flow and blood loss as it has to travel upwards. Sit on
a chair with bent elbow raised resting on a table or sit on the floor with bent elbow
raised resting on a chair.

Call for help

Call for help or ring your countrys emergency number (000, 999, 001, etc,) When
calling an ambulance, tell paramedics that you are a dialysis patient, you have a
fistula which is bleeding and it is a medical emergency.
If you are alone, learn how to call emergency with one hand, or on a speaker phone.

Patients need to learn what to do and make sure the people they spend time
with also know what to do. It could save their life.

Document in patients file Fistula Health Education and the date on the Yearly Mandatory
MR21.