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Taking care of your vascular access for hemodialysis

Arteriovenous fistula; A-V fistula; A-V graft; Tunneled catheter

You have a vascular access for hemodialysis. Taking good care of your access helps make it last longer.

Follow your health care provider's instructions on how to care for your access at home. Use the information below as a reminder.

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 hemodialysis machine. After your blood is filtered in the machine, 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 or upper arm is sewn to a vein nearby.

  • This allows needles to be inserted into the vein for dialysis treatment.
  • A fistula takes from 4 to 6 weeks to heal and mature 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 2 to 4 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) or 4.5 kilograms (kg), which is about the weight of 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 flow in your access every day. The flow creates a mild vibration in the access, also called thrill. Your 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 (4.5 kg) 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

Contact 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 flow (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

References

Kern WV. Infections associated with intravascular lines and grafts. In: Cohen J, Powderly WG, Opal SM, eds. Infectious Diseases. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 48.

National Institute of Diabetes and Digestive and Kidney Diseases website. Hemodialysis. www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis. Updated January 2018. Accessed December 28, 2022.

Yeun JY, Young B, Depner TA, Chin AA. Hemodialysis. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 63.

  • Dialysis

    Animation

  •  

    Dialysis - Animation

    Your kidneys are in charge of filtering wastes out of your blood. But, if your kidneys don't work as well as they should, you may need a procedure called dialysis, a process that removes wastes in place of your kidneys. Let's talk about dialysis. Your kidneys have several important jobs. In addition to filtering your blood, they help maintain just the right balance of water, acids, and minerals in your body. They also function as part of the endocrine system producing hormones. If you've had kidney disease for many years, or your kidneys have suddenly failed because of disease or injury, your doctor may recommend that you have dialysis, a treatment that replaces some of what the kidneys do, removing waste and excess fluid from your blood. It is sometimes used as a holding treatment while awaiting a kidney transplant. Here's how dialysis works. First, your doctor will need to create an access to reach your blood vessels. If you need dialysis only for a short period of time, that access will be made using a hollow tube, called a catheter. Usually the catheter is placed into a large vein in your neck, chest, or leg near your groin. If you're having dialysis for a longer period of time, you'll need a more permanent access. To create this access, your doctor will connect one of your arteries to one of your veins. Then whenever you have dialysis, a needle is simply placed into this access area. During each dialysis session, your blood is removed from your body through the needle. It's sent across a special filter, which removes harmful substances from your blood. Then, your clean blood is sent back into your body. Often, you'll visit a special center for dialysis about three times a week. Each session lasts three to four hours. Or, you may be able to do dialysis right at home three times a week or even daily. Home sessions are shorter, about 2 to 3 hours, and they're easier for your body to tolerate. Before you perform dialysis at home, a nurse will teach you how to place the needle, how to clean the machine, and monitor your blood pressure during treatment. It's important when you're having dialysis that you do all of your scheduled sessions. Also, call your doctor right away if you have any problems, like swelling, redness, fever, a drop in blood pressure, or bleeding. These could be signs that you've developed an infection or other complication from your dialysis, and need medical attention.

  • Dialysis

    Animation

  •  

    Dialysis - Animation

    Your kidneys are in charge of filtering wastes out of your blood. But, if your kidneys don't work as well as they should, you may need a procedure called dialysis, a process that removes wastes in place of your kidneys. Let's talk about dialysis. Your kidneys have several important jobs. In addition to filtering your blood, they help maintain just the right balance of water, acids, and minerals in your body. They also function as part of the endocrine system producing hormones. If you've had kidney disease for many years, or your kidneys have suddenly failed because of disease or injury, your doctor may recommend that you have dialysis, a treatment that replaces some of what the kidneys do, removing waste and excess fluid from your blood. It is sometimes used as a holding treatment while awaiting a kidney transplant. Here's how dialysis works. First, your doctor will need to create an access to reach your blood vessels. If you need dialysis only for a short period of time, that access will be made using a hollow tube, called a catheter. Usually the catheter is placed into a large vein in your neck, chest, or leg near your groin. If you're having dialysis for a longer period of time, you'll need a more permanent access. To create this access, your doctor will connect one of your arteries to one of your veins. Then whenever you have dialysis, a needle is simply placed into this access area. During each dialysis session, your blood is removed from your body through the needle. It's sent across a special filter, which removes harmful substances from your blood. Then, your clean blood is sent back into your body. Often, you'll visit a special center for dialysis about three times a week. Each session lasts three to four hours. Or, you may be able to do dialysis right at home three times a week or even daily. Home sessions are shorter, about 2 to 3 hours, and they're easier for your body to tolerate. Before you perform dialysis at home, a nurse will teach you how to place the needle, how to clean the machine, and monitor your blood pressure during treatment. It's important when you're having dialysis that you do all of your scheduled sessions. Also, call your doctor right away if you have any problems, like swelling, redness, fever, a drop in blood pressure, or bleeding. These could be signs that you've developed an infection or other complication from your dialysis, and need medical attention.

A Closer Look

 

Self Care

 

St. Luke’s, 915 East First Street, Duluth, MN 55805 218.249.5555 | 800.321.3790

Review Date: 10/19/2022

Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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