A cimino or arteriovenous shunt or arteriovenous fistula is a small surgical procedure to connect one artery with a vein. Arterial vessels, which carry blood from the heart throughout the body, will be united with veins or veins, which drain blood back to the heart for blood vessel access during dialysis.
This procedure is also called the Cimino-Brescia fistula, which is adapted to the name of the inventor, namely doctors James E. Cimino and Michael Brescia. The main purpose of Cimino is to maintain a smooth flow of blood to the machine during the hemodialysis process.
A number of advantages of Cimino compared to other blood vessel access, namely:
- Having a risk of complications, such as infection or blood clots, is smaller than other vascular access, such as a central venous catheter.
- The resulting blood flow is most compatible with a dialysis machine.
- Cimino lasts longer compared to other vascular access.
Cimino Indications
Cimino is one of the accesses of blood vessels for dialysis purposes, besides arteriovenous graft, central venous catheter, or tunneling. Cimino is one of the mandatory procedures for patients with chronic kidney failure who will undergo repeated dialysis for a long time.
Before Cimino
Before the surgical procedure is performed, the doctor will do a blood vessel mapping using Doppler ultrasound (USG) to detect the location of the blood vessels to be put together. The use of ultrasound does not cause pain. This tool functions to change the sound waves in an organ into an image that is displayed on the monitor screen.
Cimino Procedure
The cimino procedure is performed in a hospital operating room. The Cimino procedure for adult patients uses anesthetics or local anesthetics to give a numb sensation around the surgical area, but the patient remains conscious. If Cimino is performed on pediatric patients, the doctor will use general anesthesia or general anesthesia.
After providing anesthesia, the surgeon will make a small incision in the area of the arm, usually the wrist, to connect arteries to veins.
After Cimino
Patients will be allowed to go home and the doctor will suggest a number of things to consider after the patient undergoes Cimino, including:
- Keeping the surgical wound dry until completely healed.
- Take medicines prescribed by the doctor.
- Enough rest.
- Try to position your arms higher than your heart.
- You will be asked to do a rubber ball squeezing exercise to help fistula "ripen".
Hemodialysis is done when the fistula is "ripe", a condition marked by noise during examination with a stethoscope. Cimino takes 1-4 months to "mature". Therefore, this procedure must be carried out since a few months before, at least 6 months before dialysis.
If Cimino fails, which is marked by not "maturing" the fistula, then the act of making Cimino can be repeated in a different area or make other blood vessels access to dialysis.
Cimino risk
Cimino risk is classified as very small with a success rate reaching 95 percent compared to other vascular access measures. Risks of vascular access procedures can include infection, blood clots at the Cimino site, or side effects of anesthetics such as headaches, dizziness, vomiting, and sore throat. Immediately contact a doctor if you experience symptoms, such as shortness of breath, fever, pain, swelling, skin redness, bleeding, a warm sensation around the Cimino, and finger nails blue.
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