Fistula: risks

Creating the fistula

All surgery has some risks, but these are very rare. 

Occasionally, children bleed from the fistula or have an infection. Some need to go back to the hospital and/or take antibiotic medicines to treat an infection. 

Failure to develop

Occasionally, a fistula fails to develop. Your surgeon will look for any problems immediately after the surgery. If a fistula is not working, your doctor will speak to you about different options. 

  • Your child may return to the operating theatre, so the surgeon can try to repair the fistula and make it bigger, or create a new fistula. 
  • Your child may need to have a line inserted to use over the short term or long term.
  • If the fistula does not work, and if your child is unable to have a line, your surgeon may recommend an arteriovenous graft. This is like a fistula, but an artificial tube is used to join the artery and vein. 

Steal syndrome

Sometimes, a fistula leads to less blood flow to the hand. This is called ‘steal’ syndrome – because the fistula is ‘stealing’ blood where it is otherwise needed. 

If your child says that his or her hand feels like it is tingling, numb or cold, tell a member of the nursing or medical team. Occasionally this needs surgery. 

Looking after a fistula

Your child will probably be able to go home 1-3 days after the surgery. 


The ward staff will let you know when to remove the dressing. Some children with a brachiocephalic fistula will also have a sling around their arm.

Assessing the fistula

You and your child will need to check the fistula several times a day.

  • You may be given a stethoscope. Put this over the skin of the fistula to listen for a ‘whoosh’ sound.
  • Lightly put your fingers over the skin of the fistula to feel a ‘buzz’ or a ‘thrill’. 
  • Look at the fistula to make sure it does not look different than normal – that it is not red, swollen or bruised.

If your child cannot feel the buzz – or if it is very faint – give him or her a drink of water and check again. If there is still no or little buzz, contact your unit. 


  • Your child may need to take some medicines, such as aspirin, to reduce the risk of his or her blood clotting.
  • Try to make sure your child does not wear tight clothing, or jewellery or a wristwatch, on the arm with the fistula.
  • Avoid harm to the arm. Your child can be active, but he or she should avoid contact sports such as rugby.
  • Although infections are less common than with a line, it is important to keep the area around the fistula clean to prevent infection.
  • Keep the arm warm, especially when the weather is cold.
  • Make sure that the arm with the fistula is not used to take blood samples or insert a cannula (a plastic tube). Blood pressure should not be taken on this arm.



Sometimes there is bleeding after dialysis where the needles were inserted. 

  • Apply pressure for at least five minutes – using gauze.
  • If there is no more bleeding, place a plaster over the site.
  • If there is still bleeding, apply more pressure. If it does not stop after 30 minutes, contact your renal unit.


If the fistula looks red, or if your child complains it is painful, contact your renal unit as soon as possible. This may mean that the fistula is infected, which needs quick treatment.


If your child gets dehydrated (not enough water in his or her body), this may lead to less blood flow to the fistula and may cause blood clots. If your child feels dizzy or faint, is vomiting or has diarrhoea, contact your renal unit. 

Some children will need to have more fluids for a short time. Occasionally, children need to be admitted to hospital to be given intravenous fluids (into a blood vein). 


If the fistula looks different from normal, or if the arm feels different than usual or painful, contact the renal unit straight away. 

If you think the fistula might have been injured, check how it looks and whether it is still buzzing. Contact the unit as soon as possible. 

If the fistula is cut, call 999. It may bleed heavily. While waiting for emergency services, apply pressure to the wound and raise the arm.