Preparing for a hemodialysis vascular access


For effective and safer treatment

Before you begin dialysis, a dialysis access is placed in your arm during an outpatient surgery at a surgery center.

A fistula is the first choice for dialysis access because it generally lasts longer than other types of access and has less risk of infection or clotting. However, some people may not be able to have a fistula because their blood vessels are too small. When that’s the case, a graft is considered the next best choice for dialysis access.

Be sure your kidney doctor and care team know that you want a vascular dialysis access so you can have the best start for a healthy life on dialysis. 

Fistula Access

  • For most people, this is the best choice for the safest access
  • Your own artery and vein are connected to create a safe access to your bloodstream
  • Lasts longer
  • Less risk of infection
  • Provides good blood flow for efficient dialysis
  • Less likely to develop blood clots and become blocked
  • May take several months before ready to use for dialysis, so plan ahead

Graft Access

  • A good alternative if your blood vessels are too small for a fistula
  • An artificial tubing is placed to connect your artery and vein to create a safe access to your bloodstream
  • Provides good blood flow for efficient dialysis
  • Less likely to develop blood clots and become blocked
  • Less risk of infection than a hemodialysis catheter
  • Takes at least 2 weeks before ready to use

Placing your access: step by step

Here’s a quick look at what to expect as you get your access placed. This is your first step in feeling your best and living a longer, healthier life on dialysis.

Vessel mapping

You’ll meet with your vascular access team. The surgeon and staff perform a procedure called vessel mapping. This painless procedure uses ultrasound to measure and map your arteries and veins to help the surgeon plan a successful vascular access.

Outpatient surgery

You’re scheduled for the 1-2 hour outpatient access placement surgery. The access is usually placed in your forearm or in your upper arm.

Access maturation

It takes time for the access to heal and mature to be ready to be used for dialysis. As you begin using your access, you’ll take an active role in making sure it stays clean and healthy. Be sure to tell your care team if it becomes swollen or red, or if you notice any other changes.

Answers to questions you might have

Here are some questions and answers that people preparing for access placement often ask. Reach out to your care team for more information anytime. They’re ready to help you understand and feel confident as you take this next step.

  • You may experience mild to moderate discomfort with swelling and mild bruising of your arm.
  • For a few days after surgery, keep your arm elevated on pillows as much as possible, above the level of your heart. This will reduce swelling and increase your comfort.
  • Call the surgery center if you begin bleeding, have a high fever, or other concerns.

  • Avoid anything that might limit the blood flow to your arm.
  • Wear loose clothing and avoid jewelry on that arm.
  • Don’t carry heavy bags on your access arm.
  • Don’t sleep with your head resting on your access arm.
  • Don’t allow your blood pressure to be taken on your access arm.
  • Avoid blood draws or placement of IVs in that arm.

  • Your access will look like a bulge under your skin. There may be some minor scarring from the surgery and the dialysis needles.
  • You may be able to hear or feel the blood flowing through the access.

If you can, talk to other people who have an access. Listening to their experience can help. Tell your care team about how you’re feeling and remember that your dialysis access is your lifeline to better health.

Most people live a long time on dialysis using a healthy dialysis access. You and your care team keep a close watch on the health of your access. Over the years, problems may occur once in a while, such as infection, clotting, or bleeding. When they do, your care team can help you quickly determine what needs to be done to keep your access working well for you.

  • At home, wash your access every day with an antibacterial soap.
  • Avoid scratching the skin around your access.
  • Wash your access immediately before every dialysis treatment.
  • Make sure your access is cleaned with an antiseptic before putting the needles in. Once disinfected, don’t touch your access area.
  • Avoid coughing or sneezing on your access during treatment.
  • Call your dialysis care team at once if the access area  is sore, swollen, red, or feels hot.
  • Avoid having blood pressure taken on your access arm.  Also, avoid having blood draws or IVs placed in that arm.
  • Ask your care team to teach you more about how to care for your access and view our access care tips.

Getting your access placed at a vascular access center

Take a look at the services that a vascular access center offers.

Caring for your dialysis access

Check your access often and know what a healthy access looks like.

Asking for help as you begin dialysis

There are many ways to get the support you need to begin dialysis with confidence. Learn more about our support resources.