What is a fistula?
A fistula is made when an artery and a nearby vein are sewn together. This makes a vein bigger and stronger.
What is a fistula used for?
A fistula is needed for
hemodialysis. It’s used to send your blood to the hemodialysis machine and back to your body after your blood is cleaned.
Two needles are put into the fistula in your arm each time you have a hemodialysis treatment.
Where is the fistula and what does it look and feel like?
The fistula is under your skin so you may not be able to see it at first. You should feel a vibration when you put your fingers over the fistula. This is called a “thrill” or “buzz”. Over time, the vein gets bigger and you’ll be able to see it.
Why do you need to exercise your arm that has the fistula?
Exercise gets blood flowing to your arm. This may make:
- the fistula bigger and stronger so it’s easier to feel and put a needle into it
- the muscles around the fistula firmer to support the fistula
When should you start exercising your arm?
It’s important to exercise your arm both before and after your surgery.
Before surgery
Start the exercises as soon as you find out you need a fistula. This may make the vein bigger which helps your fistula to develop.
After surgery
Start doing the exercises 2 weeks after surgery when the areas on the skin that were cut (incision sites) have healed.
When should I stop exercising?
Keep doing these exercises until your nurse tells you to stop. You should stop doing the exercises and call your access nurse or dialysis unit if:
- your fistula becomes red, painful, swollen, or is leaking (has a discharge)
- the fistula area hurts
- the “thrill” changes or is missing
- your arm or hand on the same side of the body as the fistula gets cold, pale, or blue
- your fistula feels warm when you touch it
Fistula exercises
Lower arm fistula: Exercise 1
- Hold a soft ball or rolled wash cloth in the hand that is the same side as the fistula.
- Let your arm hang down beside your body.
- Squeeze the ball or wash cloth gently and then relax.
- Repeat the squeezing and relaxing for 5 minutes.
- Do this exercise 3 to 4 times each day.
Lower arm fistula: Exercise 2
Put your lower arm (with the fistula) and wrist on a flat surface with the palm of your hand up. Your wrist should be at the edge of the surface.
- Slowly curl your wrist up and down.
- You can do this exercise with a can of soup or a small 1-pound weight.
- Do this exercise 4 times a day for 5 minutes.
Upper arm Fistula: Exercise 1 
- Hold a 2-pound weight in the hand that is on the same side as your fistua.
- Start with your arm down at your side and slowly curl your arm.
- Do this exercise 4 times a day for 5 minutes.
