Vascular access sites are required for all patients on hemodialysis. Access sites allow access to the bloodstream during dialysis treatment, which ensures proper cleaning of the blood and fluid removal. Before you start dialysis, your doctor will decide which type of access site is best for you. Discover more about the vascular access site options and how to properly care for them.* 

What are the three types of access sites?

1. Central venous catheters (CVCs) are commonly used for new dialysis patients and, ideally, for the short-term while waiting for a more permanent access site. This is because CVCs do not clean out the blood as well as other methods and carry a higher risk of infection. 
2. An arteriovenous (AV) fistula is the access most preferred by doctors, as it typically lasts a long time and provides adequate toxin and fluid removal.
3. If a doctor believes an AV fistula is not suitable for a patient, an arteriovenous (AV) graft is the next best option. 

How does an AV fistula work?

To get an AV fistula is an outpatient procedure. A local anesthetic is placed at the access site, and your doctor will create an AV fistula by connecting an artery and a vein. This is most commonly done in the arm. 

Over the next six weeks to four months, the AV fistula site matures and becomes stronger until it’s ready to use in dialysis. If properly taken care of, AV fistulas can last for years and, in some cases, decades.

How does an AV graft work?

Like an AV fistula, an AV graft is placed during an outpatient procedure. Using a man-made tube, the doctor connects an artery and a vein. AV grafts are typically done in the arm, but they can also be done in the thigh. 

AV grafts take less time than AV fistulas to mature, with an average maturation time of two to six weeks. Grafts are less desirable for long-term use, as they are at higher risk for infection and usually need to be replaced or repaired every year. 

How should I care for my AV fistula or AV graft?

Here are six tips to help keep your AV graft and AV fistula in working condition:

1.  Keep your access site clean.

Your dialysis team should teach and demonstrate to you how to properly clean your site. Infection is best treated early so let your nurse know if you have any of these signs or symptoms at your site:

• Pain
• Tenderness
• Swelling
• Redness
• Fever/flu-like symptoms

2.  Protect your access site by:

• Avoiding tight clothes, jewelry, or anything that puts pressure on your site
• Not sleeping or laying on top of your access site
• Refrain from carrying or heavy items across your access site
• Have blood pressure taken on your non-access arm
• Request blood be drawn from your non-access arm

3.  Ask your dialysis team to teach you how to check on your access site when not at dialysis.

If able, patients are encouraged to:

• Feel the vibration going through the access site and check it multiple times a day
• Listen with a stethoscope to the sound of blood flowing through your access site

4.  Ask your dialysis team and/or nephrologist about numbing creams to reduce the pain and fear of needles. 

5.  Take control of your dialysis and learn the needle-stick process. This is a great way to learn more about your access site. If interested, speak to your dialysis care team on self-cannulating, i.e., inserting your own dialysis needle into your vascular access, at your clinic. 

6.  At the end of your dialysis treatment, make sure bleeding has completely stopped by applying pressure over the access site with sterile gauze. 

*DaVita Kidney Care. (n.d.) Vascular Access: Your Lifeline to Hemodialysis. https://www.davita.com/treatment-services/dialysis/preparing-for-dialysis/planning-for-a-vascular-access