Protecting the Fistula & Future-Access Arm
The golden rule
The access limbs are the patient's lifeline. On the fistula arm (and the arm reserved for future access) place no NIBP cuff, no IV cannula and no venepuncture — use the opposite (non-dominant, non-access) arm or a foot. Position & pad the operative arm carefully and document.
Monitoring, Perfusion & Fluids
Monitoring
- Standard monitors + ECG for hyperkalaemia (peaked T-waves) & ischaemia
- NIBP on the non-access arm; temperature (keep warm — cold → vasoconstriction → poor flow)
Perfusion & heparin
- Maintain blood pressure & perfusion — hypotension → newly-formed fistula thrombosis; avoid vasoconstrictors around the fistula
- Surgeon usually gives intra-operative heparin; watch uraemic + heparin bleeding
Fluids & potassium: give fluids judiciously (avoid overload in an anuric patient); be mindful of potassium-containing fluids and monitor K⁺. Confirm a good thrill/bruit at the end and hand over the fistula-protection instructions.