Dialysis Access Care - Fistulas, Grafts, and Catheters

Your dialysis access is your lifeline: it is how your blood reaches the dialyser during each session. Looking after it is one of the most important parts of successful dialysis. This guide explains the types of access, daily care and the warning signs to report.

Types of dialysis access

There are three main types of vascular access for haemodialysis:

• Arteriovenous (AV) fistula: an artery joined to a vein by surgery, usually in the forearm. The vein grows larger and stronger, so it can take needles at every session. It is the preferred access and often lasts many years.
• Arteriovenous graft: a soft tube joins an artery and a vein when the patient's own vessels are not suitable. It can be used sooner than a fistula but usually lasts less long.
• Central venous catheter: a tube placed in a large vein in the neck, chest or groin, used when a fistula or graft is not possible or not yet ready.

Caring for a fistula

• Check it every day: you should feel a buzz (the "thrill") and, with a stethoscope, hear a whooshing sound (the "bruit").
• Keep the arm clean, washing gently with soap and water.
• Avoid tight jewellery, watches or sleeves on that arm.
• Do not allow blood pressure measurements, blood tests or drips in the access arm.
• Do not sleep on the arm or carry heavy bags with it.
• Do not scratch needle sites. After needles are removed, apply gentle pressure as you were taught.

Caring for a graft

Graft care follows the same principles: check the thrill and bruit daily, protect the area from knocks and pressure, keep it clean and watch for signs of infection. Grafts clot more easily than fistulas, so report any change straight away.

Caring for a catheter

• Never touch the catheter or its connections with unwashed hands.
• Keep the exit site clean, dry and covered. Dressings are changed according to your centre's protocol.
• Keep the dressing dry in the shower with a waterproof cover. Swimming is not advised with a catheter.
• Look at the exit site every day for redness, swelling, discharge or pain.
• Keep the catheter secured so it cannot be pulled.

When to call your dialysis centre

Contact your dialysis team straight away if you notice:

• A weaker or absent thrill or bruit
• Redness, warmth, swelling or pain at the access
• Discharge, pus or an unusual smell
• Bleeding that does not stop with pressure
• Numbness, tingling, coldness or new pain in the hand
• Fever or chills, which can mean infection

Complications and treatment

Possible problems include infection, clotting, narrowing of the vessel (stenosis), swelling of the vessel wall (aneurysm) and "steal syndrome", when blood is diverted from the hand. Many can be treated if caught early, with antibiotics, medicines that dissolve clots, angioplasty or surgery. Your vascular surgeon and dialysis team work together on this.

Exercises after fistula surgery

After a fistula is created, your surgeon may ask you to do hand exercises, such as squeezing a soft ball, to help it mature. Follow the plan you are given, and stop and tell your team if you feel pain.

Protecting your access for the long term

• Needle sites are rotated to avoid damaging the vessel.
• Tell your team if needling becomes difficult.
• Good blood pressure and blood sugar control protect your vessels.
• Avoid smoking, which damages blood vessels.
• Keep all your access check-ups.

When you travel, take the details of your access type and your usual needling in your dialysis report, so the host centre can care for it in the same way.

Sources

• National Kidney Foundation – Hemodialysis Access
• National Kidney Foundation – Hemodialysis Catheters

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