Makomed's Weblog

Fistula of Fury

Posted on: August 22, 2009

I barely touched the patient’s bicep before her daughter screams out “OH NO DON’T TAKE THE BLOOD PRESSURE THERE!” Usually it’s because there was an AV fistula placed on the arm.


Why I tolerate the five-second explanation later, I do not know. “It’s for her dialysis, and you should never EVER take the blood pressure there, understand?”

I want to smack her at this point, but with experience I’ve learned it’s easier and faster to just let them feel entitled to the lesson rather than verbally shove it back at her just to prove my intellect.

Still, I need to know the exact cause for this anomaly. It looks like somebody swung a baseball bat at the patient’s arm since it looks so purple and swollen. I’ve seen some patients who have had it for a while and their biceps look like a freak version of ragdoll, or a victim from one of the Saw movies.

I see now that an AV fistula is created for patients with end-stage renal disease and require hemodialysis. A person needs one if he/she frequently goes to dialysis due to its ability to handle more volume pressure when the blood is circulated back to the body from the hemodialysis machine. Therefore, an artery and a vein are sewn together and this is known as an AV fistula.


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