Types of Fistula: AV Fistula for Dialysis, Fistula Needles, and Treatment Options

A fistula is an abnormal connection or passageway between two organs or vessels in the body, often created surgically for medical purposes, such as facilitating dialysis. This blog explores various types of fistulas needles like Vital Disposable A.V. Fistula Needle Set, Dora AV Fistula Needle and various brands focusing on arteriovenous (AV fistula for dialysis) fistulas used for dialysis, the specialized needles employed in their treatment, and the available options for managing and caring for fistulas. It aims to educate readers about the importance of AVfistula for dialysis in renal therapy, the functionality of fistula needles, and the treatment strategies to ensure optimal outcomes for patients undergoing dialysis.

What is a Fistula?

An arteriovenous (AV fistula for dialysis) fistula is a surgical connection created between an artery and a vein by a vascular specialist, usually in the arm but sometimes in the leg if needed. This procedure allows blood to flow directly from the artery into the vein, increasing both the blood pressure and flow within the vein. As a result, the veins enlarge, accommodating the necessary blood volume for effective hemodialysis treatment. AV fistulas are considered the best option for long-term dialysis access because they have a longer lifespan than other types, are less susceptible to infection and clotting, and provide consistent performance for dialysis patients.

Different Types of Fistulas

Fistulas can be categorized into several types based on their location and function:

Arteriovenous (AV) Fistula

This is a surgical connection between an artery and a vein, often created for patients undergoing dialysis. It facilitates increased blood flow, making it ideal for long-term vascular access.

Intestinal Fistula

This type forms an abnormal passage between the intestine and another organ or the skin, often resulting from surgery, inflammation, or disease. It can lead to complications like infection and malnutrition.

Urinary Fistula

This occurs when there is an abnormal connection between the urinary tract and another structure, such as the vagina or rectum. Conditions like childbirth complications or pelvic surgeries can lead to urinary fistulas.

Obstetric Fistula

Specifically related to childbirth, this type often results from prolonged labor and can create a connection between the vagina and bladder or rectum, causing significant physical and social challenges for affected women.

Fistula Needle: Essential Tool for Dialysis

A dialysis fistula, also known as an arteriovenous (AV) fistula, is specifically created by surgeons to facilitate dialysis treatment by connecting an artery and a vein. Unlike other AV fistulas that may form due to injuries, this surgical procedure intentionally increases blood flow through the vein. By directing faster, higher-pressure blood from the artery into the vein, the vein becomes thicker and wider, which is advantageous for accommodating dialysis needles and allowing for efficient blood circulation during treatment. Your healthcare team will discuss the benefits and risks associated with having a dialysis fistula, as well as provide guidance on how to care for it at home.

Types of Fistula Needles for Dialysis

The types of arteriovenous (AV) fistulas used for dialysis include:

Radiocephalic (Brescia-Cimino): This is the most common type, connecting the radial artery to the cephalic vein at the wrist.

Brachiocephalic: This type links the brachial artery with the cephalic vein in the forearm.

Transposed Brachiobasilic: This fistula connects the brachial artery to the basilic vein in the upper arm.

Doctors may choose for a brachiocephalic or transposed brachiobasilic fistula if a radiocephalic fistula is not viable.

Best Treatment for Fistulas: What Are Your Options?

The best treatment for fistulas can vary depending on their type, location, and underlying causes. Here are some of the best approaches, encompassing both surgical and non-surgical methods:

Surgical Treatments

1. Fistula Repair: Surgical intervention often involves closing the abnormal passage. This can include excising the fistula and reconnecting the affected tissues or organs.
2. Fistula Diverting Procedures: In some cases, surgeons may divert the flow of fluids away from the fistula to reduce symptoms and promote healing.
3. Seton Placement: A seton (a type of drainage device) may be placed in certain fistulas, such as anal fistulas, to promote drainage and allow for gradual healing.
4. Flap Procedures: For complex fistulas, such as obstetric fistulas, surgeons may use nearby tissue to cover the defect, helping restore normal anatomy.

Non-Surgical Treatments

1. Medications: In cases like anal or intestinal fistulas, medications may be used to manage infections or inflammation. Anti-inflammatory drugs and antibiotics can help reduce symptoms.
2. Nutritional Support: For intestinal fistulas, nutritional support through enteral feeding or parenteral nutrition may be necessary to ensure adequate nutrition while the fistula heals.
3. Fistula Management: Regular monitoring and proper wound care can help manage symptoms and prevent complications, especially in cases of urinary or vaginal fistulas.
4. Endoscopic Techniques: Some fistulas can be treated using endoscopic methods, where instruments are guided through the gastrointestinal tract to close or manage the fistula.

Safety Precautions for Fistula Use in Dialysis

When handling fistula needles and maintaining arteriovenous (AV) fistulas, adhering to important safety precautions is essential to prevent complications and ensure effective dialysis treatment.

Safety Precautions for Handling Fistula Needles

1. Always wash hands thoroughly with soap and water or use an alcohol-based hand sanitizer before and after handling fistula needles.
2. Ensure that all needles, syringes, and other equipment are sterile to minimize the risk of infection.
3. Use the correct technique for needle insertion to avoid damaging the fistula or surrounding tissues. Be gentle to minimize discomfort for the patient.
4. Do not apply excessive pressure when inserting needles, as this can lead to complications like hematoma or thrombosis.
5. Use a designated sharps container for the disposal of used needles to prevent needle-stick injuries.

Maintenance of AV Fistulas

1. Check the fistula regularly for signs of complications, such as swelling, redness, or changes in the thrill (the vibration felt over the fistula).
2. Maintain cleanliness around the fistula site to prevent infection. Use mild soap and water for washing, and avoid using creams or lotions near the site.
3. Ensure that clothing does not constrict the fistula area, as tight clothing can impede blood flow and lead to complications.
4. Avoid activities that could cause trauma to the fistula, such as heavy lifting or contact sports.
5. Patients should be educated about the importance of caring for their fistula, including how to recognize signs of infection or complications.

How to Properly Insert a Fistula Needle

A vascular specialist performs a physical examination of your arms. Non-invasive tests, such as ultrasound, and possibly an angiogram, assess the health of your blood vessels.This process is often referred to as "vessel mapping" to determine if your veins and arteries can support an AV fistula. Once deemed a candidate, an appointment is scheduled for the AV fistula creation. Local anesthesia is administered to the chosen access site to ensure comfort during the procedure. A small incision is made to access the selected artery and vein. A surgical connection is established between the artery and vein, allowing blood to flow from the artery into the vein. Increased blood flow through the vein leads to its enlargement and thickening of the vein walls. The AV fistula requires several weeks to a month or longer to mature before it can be used for hemodialysis treatments.