Surviving and Thriving with Dialysis Access: Tips to Care for Your Access Site

When you have kidney failure, hemodialysis is a literal lifeline. Your vascular access site — or the long-lasting vascular opening that facilitates seamless, high-volume blood flow to and from a dialyzer machine — is the lifeline to your dialysis treatment.  

Taking good care of your dialysis access site helps it last longer and reduces your risk of infection, blood clots, and other complications. In this month’s blog, our team at Advanced Vascular Surgery offers expert access site care tips to help you thrive on dialysis.   

Three routes to dialysis access

Dialysis is a long-term treatment for kidney failure to replace kidney function. It’s done through a surgically created “portal” which allows your blood to flow through an outflow tube and into a dialyzer machine. The machine filters out waste and excess fluids, then returns them to your body through an inflow tube at the vascular access site. 

Dialysis is performed primarily through veins, but it requires a high-flow access point created by connecting an artery to a vein to accommodate the required blood flow. The artery provides the pressure to move blood, while the vein allows for easy, repeated needle access. There are three types of access sites: 

AV fistula 

This access site is created by surgically joining an artery to a vein, which causes the vein to enlarge and become stronger and thicker, facilitating easier needle insertion and improved blood flow. It’s the preferred vascular access type for its strength, longevity, and low risk of infection and thrombosis.   

AV graft 

This access site is created by using a soft, synthetic tube called a prosthetic graft to connect an artery to a vein. It’s the next-best option when blood vessels aren’t strong enough for AV fistula surgery. During dialysis, needles are inserted into the graft. 

Catheter

A venous catheter is a tube that’s inserted directly into a large vein, usually in the neck, for temporary or urgent vascular access. This short-term solution is typically used to start dialysis right away while a patient waits for their AV fistula or graft to heal.

Caring for your dialysis lifeline 

Proper vascular access site maintenance is crucial, as it is truly your lifeline for dialysis treatment. Proper care helps prevent life-threatening complications like infection, clotting, or narrowing of the vessels (stenosis).

General care for all access types

Regardless of whether you have a fistula, graft, or catheter, follow these universal rules:

Practice strict hand hygiene

Always wash your hands with antibacterial soap before and after touching your access site.

Keep the site clean and dry

Wash your access area daily with warm water and antibacterial soap. Don’t apply lotions, creams, or powders near the access site. 

Avoid pressure on the site 

Don’t wear tight clothing, watches, or jewelry over the access area. Avoid heavy lifting (10 pounds or more) with your access arm, and don’t sleep directly on the access site.  

Protect the access area

Be careful not to bump, cut, or otherwise injure your access arm. Never allow anyone to take your blood pressure, draw blood, or start an IV in your access arm.

Perform daily inspections

Every day, check your access site for signs of irritation, injury, or infection (i.e., pain, redness, swelling, warmth, drainage).

Care for AV fistulas and grafts

If you have an AV fistula or graft, you’ll also need to: 

Check the “thrill” and the “bruit”

Feel your access site for a humming vibration (thrill) and listen for a low-pitched whooshing sound (bruit) daily. If this changes or stops, call our team immediately.

Rotate the needle sites

Ensure your dialysis team uses a different access site for each treatment to avoid access-site damage and maintain a strong vascular wall.

Don’t apply too much pressure

Apply mild to moderate pressure to stop bleeding after dialysis needles are removed — but not so much that you can’t feel the thrill. 

Handle scabs gently

Don’t scratch or pick at scabs near the access site; doing so can lead to major bleeding and/or infection. 

Care for venous catheter access 

Catheters have a higher risk of infection and require extra caution. 

Keep it completely dry

Always keep your dressing and exit site dry. Use a waterproof cover when showering (if permitted by your care team).

Never leave it open to the air

The catheter lumens must remain clamped and capped at all times when not in use.

Wear protective masks

Both you and your caregiver should wear masks whenever the catheter is open for dialysis or dressing changes.

Expert dialysis access support 

With offices in Kalamazoo, Allegan, Battle Creek, Coldwater, Sturgis, and Three Rivers, Michigan, our experienced team at Advanced Vascular Surgery offers a full scope of dialysis access services, from vascular access site creation to routine maintenance. 

Whether you need help with your access site or you’re looking for specific care tips and advice, we’re here to help. Call or click online to schedule your visit today.