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What to Expect After Your Surgery

What to Expect After Peritoneal Access Surgery

You have just had a peritoneal dialysis (PD) catheter placed in your abdomen. In the next few weeks, you will be working with a peritoneal dialysis nurse to learn how to manage your PD on your own.

The area around your catheter needs time to heal, so please take care not to put strain on the area or disturb the dressing.

Feeling some pain around the site and noticing a small amount of draining on your dressing is normal. If the dressing is soaked with blood, or if you see thick, yellow discharge on the dressing (pus), please call your PD or dialysis access nurse coordinator.

What to Expect After Hemodialysis Permacath Access Surgery

You have just had a hemodialysis catheter, or "permacath" placed. One end of the catheter is in a vein in your neck, the other end is in your chest.

You will have two dressings: one over the small incision in your neck, another on the catheter in your chest.

Some pain, slight bruising, and swelling are normal on both your chest and neck. Also, a small amount of drainage on your dressings is normal.

Please call your dialysis access nurse coordinator if:

  • Pain, bruising or swelling gets worse over the next few days
  • Dressing is soaked with blood, or if you see thick yellow drainage (pus) on a dressing

What to Expect After Hemodialysis Fistula or Graft Access Surgery

You have just had surgery to place an Arteriovenous (AV) fistula or shunt by directly sewing an artery to a vein in your arm. Or, if fistula access was not feasible, you have had an AV graft placed in your elbow or armpit. Both procedures create an access for the needles that will be used in your hemodialysis.

AV Fistula

A surgeon creates an AV fistula by connecting an artery directly to a vein, usually in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. Over time, (in some cases as much as 2 years) the vein grows larger and stronger, making repeated insertions for hemodialysis treatments easier.

AV Graft

If you have small veins that won't develop properly into a fistula, you can get a vascular access that uses a synthetic tube implanted under the skin in your arm. The tube becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft does not need to develop as a fistula does, so it can be used sooner after placement, often within 2 or 3 weeks.

What to Expect After Access Surgery

It is normal to experience some pain and swelling over the next several days. For the first few days after your access surgery, keep your arm elevated on pillows whenever possible. Be sure to keep your arm above the level of your heart to control swelling and ease any discomfort you may be feeling.

Your arm may bruise slightly. It is normal to see some blood oozing through the dressing. If blood is soaking the dressing or if you see thick, yellow drainage on the dressing, please contact your dialysis access nurse coordinator.

You can expect to feel a "buzzing" sensation through the bandage. The buzzing is normal and means that the access is working and blood is flowing through it. This sensation will increase over the next several days.

You should be able to move your hand normally. Your sense of touch in your hand should be normal as well. If you cannot move or feel things in your hand normally, please contact you dialysis access nurse coordinator.

The appearance and general feeling of your hand on the access side should be normal. If your hand becomes pale, blue, or turns cold, please contact your dialysis access nurse coordinator.

Your Medications

Regardless of which type of access surgery you have had, your doctor will discharge you with a prescription for pain medication. Please take as directed. The medicine should ease the soreness at the access site, although you can expect to feel some discomfort over the next few days. If pain at the site becomes severe or does not get better when you take the medicine, please contact your dialysis access nurse coordinator.

The pain medication may cause constipation. Talk with your own doctor about whether you need to take a stool softener or mild laxative.

We recommend that you do not take the prescription pain medication for longer than three days. If you feel you need pain medicine for longer than three days, please contact your dialysis access nurse coordinator.

If you were taking blood thinners such as aspirin or warfarin (Coumadin) before surgery, please talk with your doctor about when to resume this medication. You should go back to taking any other medicines you were on before surgery.

Contact Information

Transplant Institute
Beth Israel Deaconess Medical Center
Lowry Medical Office Building, 7th Floor
110 Francis Street
Boston, MA 02215
617-632-9700