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Preparing for Hemodialysis: Vascular Access

What is a vascular access?

Hemodialysis uses a machine to clean your blood. During treatments, your blood travels through a tube into the machine. There, it goes through a special filter (called a dialyzer), which removes waste and fluid. The cleaned blood then flows through another tube back into your body.

Before you can have hemodialysis, you will need to have a “vascular access.” This is the place on your body where your blood goes in and out during treatments. There are different types of vascular access. Talk to your doctor to decide which kind of vascular access is best for you.

What are the types of vascular access?

There are two main types of vascular access:

AV fistula

Drawing of the underside of a forearm with an arteriovenous fistula. Arrows show the direction of blood flow. Two needles are inserted into the fistula. Labels explain that one needle carries blood to the dialysis machine and the other needle returns blood from the dialysis machine.

An AV fistula is when an artery is directly connected to a vein. This is done by surgery. It is usually done in your non-dominant arm (the arm that you do not use as much). If you’re right-handed, it would likely be done in your left arm.

A fistula is the best type of vascular access. It is the least likely to have infections and blood flow problems. But, a fistula does need time to heal and “mature” before it’s ready to use. It is best to get a fistula a few months before you start your treatments.

AV graft

An AV graft is when a special tube connects an artery to a vein. This is also done by surgery and is usually in your non-dominant arm. Unlike a fistula, a graft is often ready for use in just a few weeks.

A graft is more likely to have problems with infection than a fistula. Still, a graft may be a good option if a fistula won’t heal well or if you have small veins.

Do I have any other options?

A central venous catheter is another type of vascular access. It is a tube that goes directly into a vein, usually in your neck or chest. Out of all the types of vascular access, catheters are the most

Image of a venous catheter inserted through the skin near the collarbone. The catheter is connected to the large vein from the heart. The other end of the catheter branches into two portals.

likely to become infected and have flow problems. A catheter does not need time to heal, so it can be placed right before your first dialysis treatment.

A catheter is a “last resort” option. It should only be used in an emergency and for a short amount of time.

How can I care for my vascular access?

Because your AV fistula or graft allows you to get the treatment you need, you might call it your “lifeline.” Below are some ways to care for your vascular access.

For all types of vascular access:

  • Keep your vascular access clean and dry at all times.
  • Ask your doctor or nurse if you have any questions.

For catheters:

  • Avoid showers and swimming.

For AV fistulas and AV grafts:

  • Avoid sleeping on your access arm, and keep tight clothing and
    jewelry away from your access. As a general rule, anything that
    leaves a mark is too tight.
  • Ask your nurse how to check the pulse in your access. Check it every day, and call your doctor
    or dialysis center if you notice any swelling or redness around your access.
  • Be careful not to bump or cut your access. Also, don’t lift heavy objects that may press directly
    on your access.

Other common questions:

You might feel like you’re alone, but many people who are about to start dialysis have many of the same concerns, like:

  • Will I have to get needles put in at each treatment?
    At each of your dialysis treatments, a nurse or dialysis technician will put two needles into your vascular access. If needle placement hurts too much, you can ask your doctor for a numbing cream. You can also learn how to put in the needles yourself, which might help.
  • What will my vascular access look like?
    Your vascular access is a bulge under the skin. You will have some scarring from the surgery and needle placements as well. Talk to your doctor, nurse, social worker or other patients if you are worried.
  • What should I wear to dialysis treatments?
    You should wear loose clothing to dialysis treatments. There is also special clothing for people who get dialysis. This clothing makes it easier for nurses to get to your access site. You can find “access clothing” online, or ask your nurse or dialysis technician about it.
  • Will I be cold during dialysis?
    People do become cold during dialysis, so you may want to bring a blanket, gloves and/or sweater with you.

Additional resources:

National Institute of Diabetes and Digestive and Kidney Diseases: www.kidney.niddk.nih.gov

Kidney School: www.kidneyschool.org

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