中文版
先別只看大小。醫師還會看它變大的速度、上面的皮膚，以及洗腎時是否出現異常，才能判斷需不需要處理。
廔管變粗，不一定就是出問題
- 自體動靜脈廔管建立後，流過靜脈的血液增加，血管會逐漸變粗，讓洗腎時比較容易扎針。
- 但如果某一段特別鼓起，或持續變大，就需要讓透析團隊檢查。這可能涉及血管局部擴張、反覆穿刺，或血液回流不順等問題，不能只靠外觀自行判斷。
比「凸多大」更值得注意的變化
- 鼓起的地方短時間內明顯變大。
- 上面的皮膚變薄、繃緊、發亮。
- 出現不容易癒合的傷口，或反覆結痂、滲血。
- 洗腎後止血比平常久，或沒有扎針也出血。
- 合併疼痛、紅腫、發熱或滲液。
- 發現這些變化，應儘快聯絡透析團隊安排評估。如果皮膚已破損，或曾經自行出血，即使目前止住，也不要等到下一次例行回診。尤其是鼓包上反覆不癒合的痂，不能只當作普通針孔結痂。
需要處理，就一定要把廔管拿掉嗎？
- 不一定。醫師會檢查血管、皮膚與透析功能，必要時用超音波了解血流、狹窄或血栓等情況。
- 狀況穩定、沒有危險徵象的廔管，可能先追蹤；若持續變大、皮膚有破損風險，或已影響使用，就可能需要修補或其他處理。也會評估能否保留可用的通路，但不能事先保證。
- 如果同時有回流狹窄，也要一併評估。不是每個鼓包做一次氣球擴張就能解決。
平常可以怎麼保護它？
- 不要揉捏、按摩鼓起的地方，也不要自行摳掉反覆結痂的部位。每次洗腎前，主動把新出現的變化告訴護理師，讓團隊評估適合的下針位置；皮膚薄弱或有傷口的地方，不應照常反覆扎針。
- 熟悉自己的廔管平常長什麼樣，比自行量出一個數字更有用。就算沒有疼痛，也不能忽略皮膚變薄或傷口不癒合。
如果突然大量出血，怎麼辦？
- 立即用手指對準出血點持續用力按壓，可以隔著小片乾淨紗布，同時請旁人撥打 119，告知「洗腎廔管大量出血」。獨處時可用手機擴音求救。
- 不要反覆放手查看，也不要為了摸震顫而鬆開按壓。大量出血即使暫時止住，仍需要急診評估，不要自行開車就醫。
提醒：廔管還能洗腎，不代表所有變化都可以忽略。變大得快、皮膚變薄、傷口不癒合或自行出血，都值得及早讓醫療團隊知道。
English
Size alone does not determine treatment. The team also considers how quickly it is changing, the skin over it and any problems during dialysis.
A larger fistula is not always a problem
- After an arteriovenous fistula is created, increased blood flow helps the vein enlarge so it can be used for dialysis needles.
- A particularly prominent or growing bulge should be assessed by the dialysis team. Local vessel enlargement, repeated punctures or impaired outflow may be involved. Appearance alone cannot identify the cause.
Changes that matter more than size alone
- A bulge that grows noticeably over a short period.
- Skin that becomes thin, tight or shiny.
- A wound that does not heal, recurrent scabbing or oozing blood.
- Bleeding that takes longer than usual to stop after dialysis, or bleeding without a needle puncture.
- Pain, redness, warmth or discharge.
- Contact the dialysis team promptly about these changes. Broken skin or spontaneous bleeding needs urgent assessment even if bleeding has stopped. Do not wait for the next routine visit. A recurring, unhealed scab over a bulge should not be dismissed as an ordinary needle-site scab.
Does treatment mean losing the fistula?
- Not necessarily. Assessment includes the vessel, skin and dialysis function. Ultrasound may be used to examine flow, narrowing and clots.
- A stable access without concerning features may be monitored. Continued enlargement, threatened skin or impaired use may require repair or other treatment. Preserving usable access is considered, but cannot be guaranteed.
- Any associated outflow narrowing also needs assessment. Balloon angioplasty alone does not solve every bulge.
How can you protect the access?
- Do not squeeze or massage the bulge or pick off recurring scabs. Tell the dialysis staff about changes before treatment so they can assess suitable needle sites. Thin or damaged skin should not continue to be repeatedly punctured.
- Know what your fistula normally looks like. Do not rely on a size measurement alone, and do not ignore thin skin or an unhealed wound just because it is painless.
What if heavy bleeding starts?
- Apply continuous firm finger pressure directly over the bleeding point, using a small clean gauze pad if available. Ask someone to call 119 in Taiwan and report heavy bleeding from a dialysis fistula. If alone, use your phone's speaker function while maintaining pressure.
- Do not repeatedly release pressure to check, or let go to feel for the thrill. Heavy bleeding still requires emergency assessment even if it stops. Do not drive yourself.
Note: An access that still works for dialysis can still have problems. Report rapid growth, thin skin, an unhealed wound or spontaneous bleeding promptly.
References
- National Kidney Foundation. KDOQI 2019 Update implementation tool: AV Access Aneurysm and Pseudoaneurysm Management (CPG 17). 查看來源
- Aitken E, et al. UK Kidney Association Clinical Practice Guideline on vascular access for haemodialysis. BMC Nephrol. 2025;26:461 (guideline finalised April 2023). 查看來源
- Guy’s and St Thomas’ NHS Foundation Trust. Looking after your arteriovenous fistula or graft. 查看來源
- Dorset County Hospital NHS Foundation Trust. Management of Life Threatening Bleed from Haemodialysis Fistula or Graft. 查看來源
本篇為一般衛教，不能取代個別醫療評估。
Dr LiangVascular
從完整評估開始
先整合症狀、理學檢查與超音波結果，再討論適合的治療選擇。
預約門診