Kidney Disease: How to Care For Your Vascular Access

Picture of the process of hemodialysis

Before you start hemodialysis, your doctor will create a site where the blood can flow in and out of your body during your dialysis sessions. This site is called the vascular access. It may be a fistula, made by connecting an artery and a vein. Or it may be a graft, which is a tube implanted under your skin.

For dialysis to work best, your vascular access needs to allow a good, steady blood flow. It also needs to be sturdy, since it will be used many times each week.

You will play an important part in protecting your vascular access. By learning how to care for your access, you will help avoid problems and get the best results from your dialysis treatments.

Care for a new vascular access

Right after the operation to create your access:

  • Your arm will probably be bruised and swollen. Keep your arm raised to help reduce swelling. You can prop it on a pillow.
  • Keep your bandage dry and clean. Change a dirty or bloody bandage.
  • Watch for signs of problems. Call your doctor or dialysis team right away if you have signs of infection.

If you have a fistula, start exercises to help develop your fistula once your stitches are removed. Your doctor will recommend exercises, such as squeezing a rubber ball. No special exercises are needed for a graft.

General care guidelines

Your dialysis nurse will teach you how to take care of your catheter and access. Take some basic precautions to keep your access healthy:

  • Keep your access clean, and check it every day for signs of infection.
  • Before each dialysis session, wash your access arm well.
  • Every day, check your access for a pulse or "thrill" in the fistula or graft area. A thrill is a vibration. To feel a pulse or thrill, place the first two fingers of your hand over the access. If you cannot feel anything, listen to the access with a stethoscope. You should be able to hear a regular whooshing sound. This is called a bruit (say "BROO-ee").
  • Partner with your dialysis technicians and nurses. You can help them remember to change needle sites at each treatment.

Protect your access:

  • Do not sleep on or lift heavy objects with your access arm.
  • Avoid bumping or hitting your access.
  • Do not wear tight sleeves or jewelry on your access arm.
  • Do not let anyone take a blood pressure reading or a blood draw on your access arm.
  • Make sure all health professionals you deal with know you have a vascular access.

When to call your doctor

Keep the phone numbers of your doctor and dialysis center with you at all times. Call your doctor or dialysis team right away if you have any signs of infection or a blood clot.

You may have an infection if:

  • You have increased pain, swelling, warmth, redness, or numbness.
  • You have red streaks leading from the site of the access.
  • You have blood or pus draining from the access.
  • You have swollen lymph nodes in your neck, armpits, or groin.
  • You have a fever.

You may have a blood clot if:

  • You have numbness or tingling in your hand or arm.
  • Your hand or arm is cold or dusky-colored.
  • You have sudden bulging around your access.
  • You have no pulse or thrill in your access.
  • You hear no sound of blood (bruit) in your access.

Call anytime you think your access is not working or you notice changes in your access.