I Want to Know About My Dialysis Access

What is a vascular access for hemodialysis?

Your vascular access is a way to bring your blood out of your body so it can be cleaned by hemodialysis and returned to you. The best type of vascular access is created under your skin, using your own blood vessels.

Fistula access for hemodialysis

An arteriovenous (AV) fistula surgically connects your artery and vein. Fistulas are the least likely to become infected or clotted, and can sometimes last for decades. They are the very best kind of access. When you first get a fistula, it will take a few months to mature. You can help the process by squeezing a rubber ball in the hand of your fistula arm.

Graft access for hemodialysis

An arteriovenous (AV) graft uses a piece of artificial vein to connect your artery and vein. Grafts need "tune-ups" more often than fistulas, but with good care, a graft can last for a few years. A graft can be used in a few weeks.

Here are some ways to care for your fistula and graft

• Keep your access arm clean, and watch for signs of infection such as tenderness, swelling, redness, fever or flu-like symptoms. If an infection is caught early, it can often be easily treated with antibiotics.
• Avoid tight clothing or lying on top of your access arm while you sleep — these can slow the blood flow through your fistula or graft and raise the risk of clotting.
• Need to have your blood pressure measured or blood drawn? Insist that the staff use your non-access arm. If you must have blood drawn from your access arm, the veins in your hand are the safest ones to use.
• Feel the “thrill” or vibration of blood through your access several times a day. If the flow stops or even feels different, this could mean a blood clot. Call your dialysis care team right away. With quick action, many clots can be dissolved or removed.
• Each day, use a stethoscope to listen to the “bruit” or whoosh-whoosh of blood through your access. If the bruit gets higher in pitch, like a teakettle, it could mean narrowing of the blood vessels. If the bruit stops, you may have a blood clot. Call your dialysis care team right away if you notice a change.
• Always wash your access arm well before each dialysis treatment, as your care team teaches you.
• Be sure the care team member who will put needles into your access has clean hands and fresh gloves.
• Some dialysis centers — and some patients — have a “three strikes and you’re out” rule for their access. If a care team member cannot place the needles in three tries, someone else takes a turn. If you have an access that is difficult to stick and you find someone who is very good at sticking it, you may want to ask the charge nurse for that care team member if she or he is available.
• At each dialysis, the needle sites should be at least half inch away from the sites used the last time. Know where your next needle stick should be, or better yet, learn to put in your own needles. Good “sticks” can help keep your access working well.
• Your dialysis team will teach you how to hold your needle sites to stop the bleeding after a treatment. Be sure to wear a glove when you do this.

How can I care for my dialysis catheter?

A catheter is a plastic tube placed into a central vein in the neck or chest by a surgeon. Temporary catheters are held in place with stitches. Permanent catheters, meant to be used for a longer time, may be held in place by a special cuff under the skin and a few stitches. Catheters are a way to immediately access your blood for hemodialysis but are not recommended to be used for a long time.

Because catheters are both inside and outside your body, they are very prone to infection.

To care for your dialysis catheter

• It is very important to always keep your catheter clean and dry. This may mean you can’t swim or take showers or baths, but need to wash up with a washcloth instead. Ask your doctor to be sure you understand how to protect your catheter.
• Be careful not to pull or tug on the catheter, especially while getting dressed and undressed. Your care team should teach you how to put a dressing over the catheter to protect it while it is not being used for dialysis.
• Watch for signs of infection: redness, swelling, pain, pus or fever. Call your dialysis center right away if you notice any of these.
• During dialysis, be sure the staff person who will connect your catheter to the dialysis tubing washes his or her hands first and wears gloves and a mask. You should wear a mask, too. The ends of the catheter should never be left open to the air.
• Catheters can be "positional.” This means they may work better when you are sitting in one position than if you sit another way. Pay attention to what works best so you can tell your staff and get the best possible treatment.
• Some people carry staph bacteria in their noses and throats without getting sick. If you are a staph carrier, ask your doctor about an antibiotic ointment you can put in your nose before dialysis. This can keep you from breathing staph germs onto your catheter and getting an infection.
• Never use scissors near or around your catheter for any reason. With good care, a catheter can be a helpful “bridge” while your fistula or graft is healing or can allow you to have dialysis when other forms of access are not available.

Peritoneal dialysis (PD) catheter

For peritoneal dialysis (PD), an abdominal catheter (tube) is a way to fill your peritoneal cavity with dialysis fluid and drain it out again. A PD catheter is ready to use two weeks after it is surgically placed, or even sooner in some cases.

As part of your PD training, you'll learn how to care for your catheter and prevent infections. Follow your care team's advice, and ask your PD nurse if you have questions.

Here are some ways to care for your PD catheter

• Before you do a PD exchange or exit site care, put on a mask and scrub your hands well with liquid soap. Clean under your fingernails, between your fingers, the backs of your hands, and your palms. Use a timer to be sure you wash long enough, and make lots of lather to wash germs away.
• Dry off with clean paper towels. Use a paper towel to turn off the faucet so your hands stay clean. Don't touch anything other than your catheter once your hands are washed. This will help you avoid infection.
• Look at your catheter and tube each day: Are there cracks or holes? Look at your exit site: Is it red, swollen, painful or draining? If you see any of these problems or if your exit site feels tender or hardened, call your dialysis center.
• Wash the skin around your exit site once a day, the way your PD nurse teaches you, start close to your catheter and move away in an outward motion. Rinse the soap off in the same way. Pat skin dry.
• Apply antibiotic preparation recommended by your doctor to the catheter exit site to help reduce the risk of infection.
• Fasten your catheter to your skin so it does not move around, using tape or a special “PD belt” to keep the catheter and tubing from pulling.
• It's safest to avoid swimming and tub baths. If you do get your doctor's permission to swim, the ocean or a private, well-chlorinated pool are better choices than hot tubs, public pools, lakes or rivers. Follow your doctor's recommendation for an exit site dressing to use during swimming. Always clean and dry your exit site promptly after getting it wet.