Hemodialysis Access
Whether you’re currently on hemodialysis or about to start, our goal is to provide you with the information you need to feel better informed and supported throughout the process. You will find specific details on the following topics:
- About Hemodialysis Access
- Types of Access
- Caring for Your Access
- Treatment for Access Problems
About Hemodialysis Access
Hemodialysis is a life-saving treatment that removes waste and excess fluid from your blood when your kidneys are no longer able to
do so. Before treatment can begin, a small surgical opening—called a vascular or hemodialysis access—must be created in a blood vessel. This access allows blood to flow through soft tubes into a dialysis machine, where it’s cleansed by passing through a special filter known as a dialyzer, and then returned safely to your body.
Types of Access
An AV (artery‑vein) fistula is the preferred choice for long-term hemodialysis because it generally lasts longer and has fewer complications, such as clotting and infection, compared to other access types of access.
A fistula is created through a minor surgical procedure in which a vein is connected to a nearby artery—typically in your wrist or elbow resulting in a larger vessel with high blood flow that can withstand the frequent needle insertions required for dialysis.
An AV (artery‑vein) graft serves as the next best permanent vascular access for hemodialysis when an AV fistula isn’t possible.
This surgical procedure involves connecting an artificial tube (typically made of synthetic graft material like PTFE) between an artery and a nearby vein—often in the bend of your arm or upper arm. In some cases, grafts may be placed in the leg or chest wall.
A catheter is ordinarily used for temporary vascular access, especially when starting dialysis before an AV fistula or graft is ready. It’s also
sometimes used long-term if fistula or graft options aren’t suitable.
Made of soft plastic tubing with two lumens — one for drawing blood and one for returning cleaned blood, it is inserted directly into a large central vein in the neck (internal jugular) or in the upper chest or groin.
Caring for Your Access
- Keep the area dry. You may shower once it has fully heals.
- Monitor for any signs of bleeding.
- Take all medications exactly as prescribed.
- Make sure to get plenty of rest.
- Keep your arm straight and elevated above heart level while the access site is healing.
Treatment for Access Problems
Even with the best care, problems with your access can still occur. If you develop an infection, your doctor will prescribe antibiotics. If a clot forms, it may need to be treated with special medications—sometimes right in the dialysis unit, or in some cases, at the hospital. Surgery might be required to remove a clot or repair the access. If the fistula or graft becomes narrowed, a procedure called angioplasty may be needed to widen it.
Your dialysis team regularly checks your access for signs of trouble, but you play an important role, too. Contact your doctor if you:
- Notice redness, pain, swelling, or warmth at the access site
- Feel numbness, tingling, or coldness in your arm
- Have shortness of breath
- Experience flu-like symptoms
- Have a temperature of 99° or higher
- Show signs of bleeding from the fistula for more than 20 minutes
