From the Guidelines
An arteriovenous (AV) fistula is typically placed in the non-dominant arm, not the dominant hand, to preserve the dominant arm for daily activities and minimize disruption to the patient's quality of life. This placement allows patients to continue performing essential tasks with their dominant hand while undergoing dialysis treatments. The non-dominant arm placement also reduces the risk of trauma, pressure, and blood draws at the fistula site, which is crucial for maintaining the integrity and functionality of the access 1.
Key Considerations for AV Fistula Placement
- The preference for non-dominant arm placement is based on the need to preserve the dominant arm for daily activities, thereby maintaining the patient's quality of life 1.
- Both arms generally have suitable vessels for fistula creation, but functional considerations make the non-dominant arm the preferred location 1.
- If vascular anatomy in the non-dominant arm is unsuitable, placement in the dominant arm may be considered as an alternative option, emphasizing the importance of individualized assessment in AV fistula placement 1.
Clinical Guidelines and Recommendations
- Clinical practice guidelines recommend the wrist (radiocephalic) fistula as the first choice of access type due to its simplicity, preservation of proximal vessels, and low complication rate 1.
- The elbow (brachiocephalic) primary fistula is considered the second choice for initial placement of an access, highlighting the importance of selecting the most appropriate access type based on individual patient anatomy and needs 1.
- The guidelines also emphasize the advantages of fistulae over other forms of access, including lower rates of thrombosis, infection, and mortality, underscoring the importance of prioritizing fistula placement whenever possible 1.
From the Research
Arteriovenous Fistula Placement
- The placement of an Arteriovenous (AV) fistula in the dominant hand is a consideration in hemodialysis access, but the provided studies do not directly address why an AV fistula is placed in the dominant hand.
- However, a study by 2 investigated the influence of AV fistula on daily living behaviors involving the upper limbs in hemodialysis patients and found that the difficulties of certain behaviors, such as writing and eating or drinking, were significantly higher in the dominant arm AV fistula group during dialysis.
- This suggests that the placement of an AV fistula in the dominant hand may affect daily living behaviors, particularly those that require motor function, during dialysis.
Considerations for AV Fistula Placement
- A study by 3 discussed the importance of preserving the left arm vein in cases of hemodialysis access generating left internal mammary artery steal syndrome, but did not specifically address the placement of AV fistulas in the dominant hand.
- Another study by 4 highlighted the goals of the Fistula First Breakthrough Initiative, which aims to increase the prevalent AVF use rate and reduce vascular access complication rates, but did not provide information on the placement of AV fistulas in the dominant hand.
- A study by 5 discussed the complexities of patient and clinician decision making in regards to AV fistula placement, but did not address the specific consideration of dominant hand placement.
- A study by 6 reviewed the most important chronic complications of AV fistulas for hemodialysis, but did not discuss the placement of AV fistulas in the dominant hand.
Daily Living Behaviors
- The study by 2 found that the placement of an AV fistula in the dominant hand can affect daily living behaviors, such as writing and eating or drinking, during dialysis.
- The study also found that the difficulties of certain behaviors, such as wearing a wristwatch and hanging a bag on the arm, were significantly higher in the non-dominant arm AV fistula group during non-dialysis periods.