How do you care for a hemodialysis access?

Why access care matters

Your access site is your dialysis lifeline. Keeping your fistula or graft healthy helps you get the best dialysis possible.

Keeping your access healthy helps to make sure:

• Your treatment is successful.
• You experience the least amount of pain and discomfort.
• You can continue to feel your best.

Caring for your access day to day

Caring for a new access

After your access site surgery, it’s important to allow time for your fistula or graft to heal. This time allows your access to grow stronger and “mature” to be ready to use.

Recovery time

• Fistula – It takes anywhere from 6 weeks to a few months to heal and be ready for use.
• Graft – May be ready to use immediately or within 2 to 3 weeks.

Fistulas need more time to heal. Your blood flow needs to increase to the right level so that your blood vessels can become bigger and stronger. A mature access will help you get the most out of your dialysis.

Tip: Ask your doctor about simple arm and hand exercises to help your fistula mature.

Practicing good hygiene

Keeping your access site clean and free from germs can help prevent infection.

• Always wash your hands before touching your access site and make sure others do too!
• Before using your access, clean your access site, arm, and hands.

Protecting your access site

Take these simple steps to protect your access:

• Wear loose clothing and jewelry on your access arm to avoid pressure.
• Learn to sleep without placing your access arm under your head or body.
• Use your other arm to carry heavy objects.
• Take your blood pressure on the arm without your access site.
• Have your blood drawn on the arm without your access site.

Keeping your veins strong

At each treatment, your care team will change the needle placement. This will help your veins stay strong and protect them from damage. It will also help you get the most out of your dialysis.

Using your access for dialysis

Placing dialysis needles into your access so dialysis can be performed is called cannulation. If you're doing at-home hemodialysis, your home therapy nurse will show you how to self-cannulate (put in your own needles).

Caring for your access in an emergency

If you notice a problem, it’s important to act quickly and get it treated as soon as possible.

Infiltration

When the needle puts a hole in the fistula/graft and causes bleeding under the skin.

How to treat:

• Day 1: Apply a cold compress to reduce swelling (15 minutes on and 15 minutes off) for 24 hours.
• Day 2: Apply moist heat to help your body absorb the clotted blood (15 minutes on and 15 minutes off) for 24 hours.

Aneurysm

When the access area expands to the point it could burst (rupture). Signs of a rupture include fast growth, tenderness, discoloration, or tight, shiny, and thin skin.

How to treat:

• If you think your access may be at risk of rupturing, call your doctor or nurse as soon as possible.
• If the area bursts at home, immediately apply direct pressure or a tight band called a tourniquet.
• Call 9-1-1.

Bleeding

When a fistula or graft is weak from repeated needles inserted in the same area, bleeding may occur. Significant bleeding is a rare problem. Let your care team know if you are bleeding between treatments.

How to treat:

• Apply direct pressure for five minutes or until bleeding stops.
• Cover with a clean bandage once the bleeding stops.
• If the bleeding doesn’t stop, continue to hold pressure, and go to the hospital immediately or call 9-1-1.

Clotted access

If there is less blood flow, it could mean your access is blocked by a clot. Signs of clotting include loss of vibration when you touch your access (called a thrill) or loss of the low-pitched swooshing sound (called a bruit).

How to treat: Notify your care team immediately. A clot could delay your next scheduled treatment. Left untreated, it could mean loss of your fistula or graft.

Quick-reference emergency guide

Condition	What It Is	How to Treat
Infiltration	When the needle puts a hole in the fistula/graft and causes bleeding under the skin.	Day 1: Apply a cold compress (15 min on/off) for 24 hours. Day 2: Apply moist heat (15 min on/off) for 24 hours to help absorb the clotted blood.
Aneurysm	When the access area expands to the point it could burst (rupture). Signs include fast growth, tenderness, discoloration, or tight, shiny, thin skin.	Call your doctor or nurse right away if you suspect rupture risk. If it bursts at home, apply direct pressure or a tourniquet immediately and call 9-1-1.
Bleeding	When a fistula or graft is weak from repeated needle insertions in the same area. Significant bleeding is rare.	Apply direct pressure for 5 minutes or until bleeding stops, then cover with a clean bandage. If it doesn't stop, keep holding pressure and go to the hospital or call 9-1-1.
Clotted Access	Reduced blood flow may mean the access is blocked by a clot. Signs include loss of thrill (vibration) or loss of bruit (swooshing sound).	Notify your care team immediately. A clot could delay your next treatment, and left untreated could mean loss of the fistula or graft.

Checking your access daily

Taking good care of your access every day can help small concerns from turning into bigger problems. Your nurse or patient care technician (PCT) can show you how to do these steps.

Step	What to do
Look	Check the area around your access site for signs of redness, swelling, or leaking.
Listen	Listen for the low-pitched swooshing sound of strong blood flow, called a bruit.
Feel	Feel your access site for good blood flow—a healthy access has a thrill, or vibration.
Check	Check your site for tenderness, warmth, or swelling, which could signal infection or clotting.

Keep your access healthy

Taking good care of your access will help you stay healthy and feel your best.

• Check your access daily. Look, listen, and feel to keep a small issue from becoming a larger concern.
• Protect your access and keep your veins strong.
• Keep your access site clean and free from germs.
• Act quickly if you notice a problem and get it treated as soon as possible.

Talk to your care team today

Your care team can answer questions and provide information about caring for your access.

This serves only as a guide. Talk with your healthcare provider for more information based on your health needs.