Caring for a dialysis fistula or graft

What is vascular access?

The arteriovenous fistula connects an artery to a vein, and the graft uses an artificial connection, while the catheter is placed in a large vein. The team chooses the vascular access according to the vessels, clinical condition, and expected time to start dialysis. Each type has benefits and risks, and no one option is right for everyone.

Simple daily check up

Ask your team to show you how to feel the usual vibration, or “thrill,” in the fistula or graft. Note any obvious change from usual, and inspect the skin visually without painful pressure. Do not allow blood pressure to be measured or blood drawn from the fistula arm unless directed to do so by the team.

Signs calling for contact

• The usual shaking disappears or changes noticeably.
• Redness, heat, swelling, pus, or increasing pain around the vascular access.
• Bleeding that does not stop after direct pressure as taught by the team.
• Extreme cold, numbness, or discolouration of the hand.
• Frequent problems during the session, such as high blood pressure or poor blood flow.

Fever or chills with signs at the vascular access may indicate an infection and requires immediate contact. In case of severe bleeding or worsening condition, call local emergency services.

Vascular access protection

Avoid compression clothing or bands, repetitive friction, lifting weights, or activity that causes arm pain. Follow the hygiene and dressing-change instructions for your unit, and do not apply ointments or antiseptics yourself.

Sources

• KDOQI Vascular Access Guidelines and Clinical Tools.
• CDC: Dialysis safety and infection prevention.