Fistula

Definition

A fistula is an abnormal tract connecting two hollow body structures or connecting a body structure to the skin surface. It may be congenital, disease-related, traumatic, or surgically created.

Clinical Examples

• AV fistula: Surgical connection for hemodialysis access.
• Enterocutaneous: Bowel to skin (post-surgical, Crohn's).
• Vesicovaginal: Bladder to vagina (obstetric trauma).
• Rectovaginal: Rectum to vagina.
• Tracheoesophageal: Congenital or acquired.

AV Fistula Nursing Care (Hemodialysis)

Assess bruit and thrill every shift (absence = clotting, emergency). DO NOT: take BP, draw blood, or start IV in fistula arm. Teach patients to avoid sleeping on that arm, wearing tight jewelry, or carrying heavy bags.

Other Fistula Management

Skin protection around enterocutaneous fistula (ostomy-type pouching). Nutritional support for healing. Surgical repair when stable.

NCLEX Relevance

Thrill + bruit = functioning AV fistula. No BP or venipuncture in that arm.