Fistula Care - VA Pittsburgh Healthcare System
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Fistula Care

What You Should Know

A newly inserted Fistula.Knowing what to expect, how to care for your fistula, and signs of problems can help you keep your fistula working for many years.


After Fistula Placement

Contact your surgeon’s or your doctor’s office and tell their staff if you notice any of the following:

  • Your incision is swollen, red, warm, or you see pus
    - these are signs of infection.
  • Your stitches come apart.
  • Your bandage becomes soaked with blood.
  • You develop a high temperature.
  • The thrill is gone.
  • A bulging in your access that previously wasn’t there.
  • Your fingers become cold, blue or numb.

After Surgery

After surgery your fistula may have a bandage to keep it clean and prevent infection. (A nurse or doctor may briefly remove the bandage and check the stitches shortly after surgery). The surgeon or the nurse will listen to your fistula and touch it. This is referred to as “listening to the bruit, and feeling for the thrill.”

Listening for a bruit with a stethoscope.Thrill & Bruit

“Thrill” is a rhythmic vibration that can be felt over your fistula, whereas “bruit” - pronounced “brew-ee” is a sound that is heard when listening to your fistula with a stethoscope. Ask the doctor or nurse to allow you to hear the bruit and show you where to best feel the thrill. Check the thrill and bruit daily.

Exercises: Lower & Upper Arm

Exercising your arm before and after surgery may encourage a fistula’s development and maturation. Fistulas may take up to 6 months to mature. Some physicians believe exercising the fistula helps it strengthen and develop. Once mature, a fistula is easier for the dialysis staff to stick for your treatment. Below are some exercise techniques that may be used to help develop your fistula.

Squeezing a rubber ball for excerise.Forearm Fistula Exercises

Ball Squeeze

As soon as the pain from surgery has subsided, start forearm exercises by squeezing a rolled-up washcloth or a “stress”
ball. Squeeze, and release rapidly for 10 minutes, 6 times a day. Additionally, you may use your other hand to squeeze the bicep of your fistula arm. This hinders blood return and causes the fistula to dilate because of increased pressure and blood in the vein.


clothespin squeeze exceriseClothes-Pin Grasp

Using a clothespin, squeeze open and allow to close repeatedly for 5 minutes, 6 times daily.


fingertip touch excerisesFinger Tip Touches

Lastly, another good exercise to help strengthen and develop your fistula are finger tip touches. Touch each finger to the tip of your thumb, opening up your hand after each touch. Touch tips to thumb repeatedly for 5 minutes, 6 times a day.


Upper Arm Fistula Exercises

Hammer Curl a photo of a woman holding a light weight much like you would hold a hammer. Hammer Curls
An effective way to exercise an upper arm fistula, (a fistula created above your elbow ) is to perform arm curls with a weight. To perform a “hammer curl”, take a 1 to 3 pound weight in the arm your fistula was created in and hold the weight as shown in this picture. Pump your arm up and relax down slowly for 10 minutes, 6 times a day.


Bicep curl. A man holding a weight with his fingers folded in towards his chest.Bicep Curl
Another easy exercise is the bicep curl. A useful, household weight is a regular can of vegetables. Holding the can, curl your arm slowly up and down for 10 minutes, 6 times daily.

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