Surgical wound care advice following your arterio-venous fistula ligation

How long will my wound take to heal?

Your wound should take between 10 to 14 days to heal.

When should I change my wound dressing?

• Leave your dressing in place for three days, and keep it dry. If your dressing becomes wet, redress with the dressing the hospital gave you.

• Do not apply creams or lotions to your wound.

• Most people do not need to keep their wound covered for more than seven days. After seven days the wound is usually dry and better left open to the air.

What sort of wound problems may I have?

• Mild pain and discomfort is normal. Take painkillers as advised by your medical professional.

• If your hand / arm becomes swollen, support it on two or three pillows when resting.

• You may have developed an infection, if your wound becomes:

  • red

  • inflamed / hot, or

  • starts discharging pus.

  If this happens, contact your GP, Haemodialysis Unit, or renal access nurse for advice.

• Slight bleeding from your wound through to the dressing is normal in the first one to two days following surgery.

• Heavy bleeding is when bleeding continues for more than five minutes, with high volumes of more than quarter of a cup. If this happens apply pressure to your wound and go to your nearest Emergency Department immediately.

• Do not remove any scabs. Scabs will come off on their own.

• Thrombophlebitis. Your fistula has been ligated (tied off), and the vein that was your fistula has been disconnected but left in place. Depending on the size of your original fistula, your surgeon may use different techniques to do this. As a result, the advice your surgeon gives you after surgery will depend on your individual case.

  The vein that was left in place can sometimes cause thrombophlebitis. Thrombophlebitis is a condition that causes a blood clot to form and block one or more veins, often in the legs. The condition affects superficial veins, which are veins that are close to the surface of the body. This is different from deep vein thrombosis (DVT). After fistula ligation surgery, thrombophlebitis can be caused by blood left in the old vein clotting. The clot is usually slowly dissolved by your body, and will eventually settle.

  Symptoms can include the following.

  • Itching

  • Dull aching / tenderness

  • Swelling

  • Hot pink / red areas along the path where the fistula used to run. This usually occurs between 1 and 3 weeks after fistula ligation, and can cause alarm if not expected. For most people taking paracetamol with a cold compress over the area and elevating (raising) their legs is enough to keep them comfortable.

  The symptoms of thrombophlebitis can be the same as those of infection. Please contact your Renal Dialysis Access team for review if you have any of the symptoms listed above.

When can I go back to my usual activities?

Gradually return to your normal activities, depending on how your wound feels. After 14 days you should be able to return to all your normal activities, unless told otherwise by your surgeon.

When can I start driving again?

Avoid driving for at least three days following your procedure. When you feel safe to drive again consider your grip, does it feel back to normal for you?

Do I need to get any stitches / clips removed?

Yes

No

When is my follow-up appointment?

Date:

Time:

Where is my follow-up appointment?

• Buckland Hospital, Dover

• Marlowe Ward, Kent and Canterbury Hospital, Canterbury

• Thomas Becket, Kent and Canterbury Hospital, Canterbury

• Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate

• William Harvey Hospital, Ashford

• Maidstone Hospital

• Medway Maritime Hospital

If you are on dialysis, your dialysis nurses will check the progress of your wound at your haemodialysis session.

If you need another appointment, you will be told by post or telephone

Who can I call for advice or with any concerns?

Please call one of the telephone numbers below or your GP surgery if you are worried.

• Renal Dialysis Access Nurses, Kent and Canterbury Hospital, Canterbury
  Telephone: 01227 864305

• Marlowe Ward, Kent and Canterbury Hospital, Canterbury
  Telephone: 01227 866456

• Thomas Becket Haemodialysis Unit, Kent and Canterbury Hospital, Canterbury
  Telephone: 01227 783047

• Haemodialysis Unit, Buckland Hospital, Dover
  Telephone: 01304 222695

• Haemodialysis Unit, William Harvey Hospital, Ashford
  Telephone: 01233 651872

• Haemodialysis Unit, Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
  Telephone: 01843 234270

• Haemodialysis Unit, Medway Maritime Hospital
  Telephone: 01634 825107

• Haemodialysis Unit, Maidstone Hospital
  Telephone: 01622 225885