Before your hemodialysis can start, an opening has to be made in your body so your blood can be accessed by the hemodialysis nurse and made to flow out and go back in. This opening is called a vascular access.
Know What Type of Vascular Access You Have
There are 3 main types of vascular access for hemodialysis.
Fistula: An artery in your forearm is sewed to a vein nearby.
This allows needles to be inserted into the vein for dialysis treatment.
A fistula takes from 1 - 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 - 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 cut down on swelling.
You can use your arm the same day as surgery, but do not lift more than 10 pounds (a gallon of milk weighs 8 pounds).
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.
Wash your hands before touching your access. Clean the area around the access with antibacterial soap or alcohol before your dialysis treatments.
Check the pulse (also called “thrill”) in your access every day. Your doctor or nurse 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 lbs 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 doctor or nurse 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 over 100.5 °F (38.0 °C)
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
Herbert Y. Lin, MD, PHD, Nephrologist, Massachusetts General Hospital; Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.