This article gives valuable information relevant to maintaining a healthy vascular access in an effort to equip kidney failure patients who are considering hemodialysis.


Before hemodialysis can be implemented patients need a working access. This means having either a fistula or graft implanted below the skin. This procedure is performed by a vascular surgeon, on an outpatient basis, in a hospital setting or through mobile vascular services. Conventionally, a fistula or graft is implanted into the upper or lower portion of the patient’s non-dominant arm. On occasion doctors may insert a catheter if the patient’s fistula or graft is not fully-developed or does not have adequate function by the time hemodialysis is initiated.

Arteriovenous (AV) Fistulas and Grafts

An arteriovenous (AV) fistula is an access in which a vascular surgeon directly connects a patient’s artery and vein to increase blood flow and to help the patient’s blood vessels support hemodialysis. An AV graft is an access created by inserting a plastic tube under the patient’s skin. It is also used to connect the patient’s artery and vein to increase blood flow and to help the blood vessels support hemodialysis. Both fistula and graft are considered permanent accesses. Each serves as a select route for blood removal and redelivery into the body during hemodialysis’ blood filtration and cleaning.

Fistulas last longer than grafts. While grafts tend to last several years, fistulas have a potential lifespan of over 35 years.

A fistula is considered (by vascular surgeons and nephrologists) the best type of access to obtain for 3 main reasons:

  1. Less chance of infection
  2. Less blood clotting
  3. Longevity

Patients with grafts are more susceptible to infections and blood clots than those with fistulas.


Some patients may not be able to receive a fistula for one or more of the following reasons:

  • Immediate need for dialysis (without enough time available to wait for a fistula to develop before dialysis needs to be rendered)
  • Small and/or weak blood vessels

In such cases, a graft or catheter is implanted to allow these patients to receive hemodialysis.

To keep your fistula or graft “alive” and healthy, follow these simple rules:


  • Keep access area clean.
  • Exercise access arm by squeezing soft (palm-sized) foam ball or cushion at least 3 sets of 10 (squeezes) every day.
  • Place a clean, lukewarm towel over access for at least 5 minutes daily to keep circulation flowing.
  • Check access daily for the “thrill” or pulse.


  • Lift more than 5 lbs. with access arm.
  • Allow anyone to take blood pressure using access arm.
  • Wear bands, jewelry or anything tight (including tight clothing) on access arm.
  • Sleep on access arm.
  • Allow injections or blood drawn from access arm.

Venous Catheters

Venous Catheters are considered temporary accesses. They are usually used on patients whose fistula or graft needs more time to develop or “mature” and until sufficient dialysis treatments through their permanent access can be rendered. Common insertion sites for catheters are: neck, upper chest, and thigh areas.

In extreme emergencies a catheter may be placed in a patient’s groin enabling that patient to receive immediate hemodialysis. A catheter in the groin is used in emergency cases only, as the patient will not be allowed to sit nor stand during its stay. The patient will remain bedridden until a more stable (although still temporary) catheter is implanted (into the neck, chest, or thigh area) or until the patient’s existing access gains adequate function-each allows for a wider range of mobility.

Of the three types of accesses available, patients with catheters are the most susceptible to infections and blood clots. As a result, catheters are only intended to be used for short periods of time (ranging from several days to several months).

If patients understand their fistula, graft or catheter before undergoing hemodialysis they can begin to take great care of their access early on. Knowing what’s required will help to ensure a healthy access, optimal hemodialysis, and good blood tests results.

Point to Ponder

This article is intended for informational purposes only. It does not take the place of a doctor’s advice. Before making decisions regarding your health, seek the consultation of a well-trained, medical professional


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