Management of Inflamed Arteriovenous Fistula After Hemodialysis

Initial Assessment and Management

The American Journal of Kidney Diseases recommends evaluating for signs of infection including erythema, warmth, tenderness, purulence, or systemic symptoms (fever, chills) in patients with an inflamed arteriovenous fistula after hemodialysis 1
If infection is present, the American Journal of Kidney Diseases suggests immediately initiating broad-spectrum antibiotic therapy with vancomycin plus an aminoglycoside, later adjusted based on culture results 1
The American Journal of Kidney Diseases recommends a complete antibiotic course of 6 weeks for AV fistula infections, similar to treatment for subacute bacterial endocarditis 1
Cannulation at the inflamed site must cease immediately, and the arm should be rested, as recommended by the American Journal of Kidney Diseases 1

The American Journal of Kidney Diseases suggests resting the fistula until swelling is completely resolved in patients with an inflamed arteriovenous fistula after hemodialysis without infection 2
Elevating the affected arm as much as possible to reduce swelling is recommended by the American Journal of Kidney Diseases 3
Applying ice to the inflamed area to help decrease pain and reduce the size of any infiltration is suggested by the American Journal of Kidney Diseases 4, 5

If swelling persists beyond 2 weeks, obtaining imaging to evaluate for potential underlying causes is recommended by the American Journal of Kidney Diseases 2
Fluoroscopy fistulography is usually appropriate as the initial imaging study for suspected dysfunction of hemodialysis access, according to the Journal of the American College of Radiology 7
Duplex ultrasound is an acceptable alternative for initial evaluation, as suggested by the Journal of the American College of Radiology 7

If the fistula is infiltrated, resting it for at least one treatment is recommended by the American Journal of Kidney Diseases 5
If dialysis cannot be postponed, cannulating above the site of infiltration is suggested by the American Journal of Kidney Diseases 5
If imaging reveals stenosis >50% with associated clinical abnormalities, proceeding with percutaneous transluminal angioplasty (PTA) is recommended by the American Journal of Kidney Diseases 9

Ensuring proper needle removal technique to prevent post-dialysis infiltrations is recommended by the American Journal of Kidney Diseases 5
Applying gauze dressing over needle site without pressure before removal is suggested by the American Journal of Kidney Diseases 5
Implementing regular monitoring of access characteristics (pulsatility, thrill, flow, pressure) is recommended by the American Journal of Kidney Diseases 3

Regular monitoring should continue after resolution to detect any recurrence, as recommended by the American Journal of Kidney Diseases 3
Evaluating for adequate blood flow before each subsequent dialysis treatment is suggested by the American Journal of Kidney Diseases 3
Recording and tracking access characteristics in the medical record to be available to all caregivers is recommended by the American Journal of Kidney Diseases 3