Hemodialysis Access

The hemodialysis (HD) access site is one of the most important factors in ensuring adequate and timely dialysis. HD access is found in all end-stage renal disease patients and those with chronic kidney disease preparing for dialysis. There are 3 types of HD access options, including a fistula, a graft, or a catheter. A fistula is where a surgeon joins the artery and vein in your arm to allow a site where undialyzed blood can leave the body and come back clean. A graft is similar to a fistula, but a soft tube is used to join an artery and a vein. A catheter is a soft tube placed in a large vein in the neck or chest. A catheter is the least desirable option, as it can be a source of infection, and is often only a temporary measure.

What are some tips and tricks to care for your access site? For fistulas and grafts, make sure you wash the site with soap and water daily, especially before HD. Monitor the skin for any new pimples, scabs, redness, warmth, or swelling. Do not pick or scratch at your skin or any scabs, as it can cause bleeding. Ensure that the HD tech rotates needle sites frequently to prevent injury to the access. Do not let any blood pressure cuff or labs be drawn on your access arm. Also, avoid tight clothes or jewelry on your access arm and avoid lifting anything heavy or applying pressure to the site. For catheter care, make sure the dressing is changed with each and every HD session. Keep the dressing clean and dry. Also, keep the catheter covered as exposing the site can increase your risk for infection.

How do you make sure you have adequate blood flow and a working access? Several times a day you should feel the access site with 2-3 fingers for a vibration, called a thrill. Ask the tech or RN to teach you how to feel for a thrill. If the vibration changes, or stops all together, please call your provider or dialysis unit immediately. A change in thrill or loss of vibration could indicate a reduced blood flow or clotted fistula or graft. In addition, breakthrough bleeding may sometimes occur at the access site. If this happens, make sure you apply gentle pressure above the site of bleeding with gauze for 30 mins. If you have continued bleeding after 30 mins call the provider or dialysis center.

Hopefully, these tips and tricks will help you maintain a well-functioning access and help you identify any problems should they arise. If you have questions or concerns, your provider, RN, or dialysis tech can help answer any questions regarding your HD access.