Taking care of your vascular access for hemodialysis
Ateriovenous fistula; A-V fistula; A-V graft; Tunneled catheter
What Is a Vascular Access?
A vascular access is an opening made in your skin and blood vessel during a short operation. When you have dialysis, your blood flows out of the access into the dialyzer machine. After your blood is filtered in the dialyzer, it flows back through the access into your body.
Know What Type of Vascular Access You Have
There are 3 main types of vascular accesses for hemodialysis. These are described as follows.
Fistula: An artery in your forearm is sewn to a vein nearby.
- This allows needles to be inserted into the vein for dialysis treatment.
- A fistula takes from 1 to 4 months to heal before it is ready to use.
Graft: An artery and a vein in your arm are joined by a U-shaped plastic tube under the skin.
- Needles are inserted into the graft when you have a dialysis.
- A graft can be ready to use in 3 to 6 weeks.
Central venous catheter: A soft plastic tube (catheter) is tunneled under your skin and placed in a vein in your neck, chest, or groin. From there, the tubing goes into a central vein that leads to your heart.
- A central venous catheter is ready to use right away.
- It is usually used only for a few weeks or months.
When You First Leave the Hospital
You may have a little redness or swelling around your access site for the first few days. If you have a fistula or graft:
- Prop your arm on pillows and keep your elbow straight to reduce swelling.
- You can use your arm after you get home from surgery. But, DO NOT lift more than 10 pounds (lb) (about a gallon of milk).
Taking care of the dressing (bandage):
- If you have a graft or fistula, keep the dressing dry for the first 2 days. You can bathe or shower as usual after the dressing is removed.
- If you have a central venous catheter, you must keep the dressing dry at all times. Cover it with plastic when you shower. DO NOT take baths, go swimming, or soak in a hot tub. DO NOT let anyone draw blood from your catheter.
Problems to Watch For
Grafts and catheters are more likely than fistulas to become infected. Signs of infection are redness, swelling, soreness, pain, warmth, pus around the site, and fever.
Blood clots may form and block the flow of blood through the access site. Grafts and catheters are more likely than fistulas to clot.
The blood vessels in your graft or fistula can become narrow and slow down the flow of blood through the access. This is called stenosis.
Day-to-day Care of Your Vascular Access
Following these guidelines will help you avoid infection, blood clots, and other problems with your vascular access.
- Always wash your hands with soap and warm water before and after touching your access. Clean the area around the access with antibacterial soap or rubbing alcohol before your dialysis treatments.
- Check the pulse (also called thrill) in your access every day. Your health care provider will show you how.
- Change where the needle goes into your fistula or graft for each dialysis treatment.
- DO NOT let anyone take your blood pressure, start an IV (intravenous line), or draw blood from your access arm.
- DO NOT let anyone draw blood from your tunneled central venous catheter.
- DO NOT sleep on your access arm.
- DO NOT carry more than 10 lb with your access arm.
- DO NOT wear a watch, jewelry, or tight clothes over your access site.
- Be careful not to bump or cut your access.
- Use your access only for dialysis.
When to Call the Doctor
Call your provider right away if you notice any of these problems:
- Bleeding from your vascular access site
- Signs of infection, such as redness, swelling, soreness, pain, warmth, or pus around the site
- A fever 100.3°F (38.0°C) or higher
- The pulse (thrill) in your graft or fistula slows down or you do not feel it at all
- The arm where your catheter is placed swells and the hand on that side feels cold
- Your hand gets cold, numb or weak
U.S. Department of Health and Human Services. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Vascular access for hemodialysis. Updated May 2014. Available at: kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/vascularaccess_508.pdf. Accessed December 26, 2014.
Yeun JY, Ornt DB, Depner TA. Hemodialysis. In: Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 64.
Deepak Sudheendra, MD, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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