Ateriovenous fistula; A-V fistula; A-V graft; Tunneled catheter
A vascular access is an opening made in your skin and blood vessel during a short operation. When you have dialysis, your blood flows out of the access into the dialyzer machine. After your blood is filtered in the dialyzer, it flows back through the access into your body.
There are 3 main types of vascular accesses for hemodialysis. These are described as follows.
Fistula: An artery in your forearm is sewn to a vein nearby.
Graft: An artery and a vein in your arm are joined by a U-shaped plastic tube under the skin.
Central venous catheter: A soft plastic tube (catheter) is tunneled under your skin and placed in a vein in your neck, chest, or groin. From there, the tubing goes into a central vein that leads to your heart.
You may have a little redness or swelling around your access site for the first few days. If you have a fistula or graft:
Taking care of the dressing (bandage):
Grafts and catheters are more likely than fistulas to become infected. Signs of infection are redness, swelling, soreness, pain, warmth, pus around the site, and fever.
Blood clots may form and block the flow of blood through the access site. Grafts and catheters are more likely than fistulas to clot.
The blood vessels in your graft or fistula can become narrow and slow down the flow of blood through the access. This is called stenosis.
Following these guidelines will help you avoid infection, blood clots, and other problems with your vascular access.
Call your provider right away if you notice any of these problems:
U.S. Department of Health and Human Services. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Vascular access for hemodialysis. Updated May 2014. Available at: kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/vascularaccess_508.pdf. Accessed December 26, 2014.
Yeun JY, Ornt DB, Depner TA. Hemodialysis. In: Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 64.
Last reviewed on: 12/26/2014
Reviewed by: Deepak Sudheendra, MD, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.