MetroHealth Heart & Vascular Center
What is Dialysis Access ?
Dialysis access is an entranceway into your bloodstream
that lies beneath your skin and is easy to use. The access is usually in your
arm or leg and allows blood to be removed and return
ed quickly, efficiently, and safely during
Dialysis, also called hemodialysis, is the most common treatment for kidney
failure. A dialysis machine is an artificial kidney designed to remove
impurities from your blood. Physicians use dialysis to circulate your blood
through the machine to remove impurities and regulate fluid and chemical
There are two types of portals:
• Fistula, which your physician creates by joining an
artery to a vein
• Graft, which is a man-made tube that connects an
artery to a vein
• For both fistulas and grafts, the connection between your artery and
vein increases blood flow through the vein. In response your vein stretches and
becomes strengthened. This allows an even greater amount of blood to pass
through the vein
• In the weeks after surgery, the fistula begins to mature. The vein
increases in size and may look like a cord under your skin.
• The whole process typically takes 3 to 6 months. Some fistulas take as
long as a year or more to develop fully.
• Once matured, a fistula should be large and strong enough for dialysis
technicians and nurses to insert the large dialysis needles easily.
• You can usually begin using your graft in 2 to 6 weeks, when it is
• Usually fistulas are preferred to grafts because fistulas are
constructed using your own tissue, which is more durable and resistant to
infection than are grafts. However, if your vein is blocked or too small
to use, the graft provides a good alternative.
What can I expect?
• Before choosing the access site, your surgeon may ask you if you have
a history or symptoms of arm or leg artery disease. Hardening of the arteries,
which reduces blood flow to your arms or legs, causes these conditions.
• Your vascular surgeon will not place a dialysis access site in an area
of the body with reduced circulation. For this reason, your surgeon usually
places dialysis access sites in the arms rather than in the legs because
atherosclerosis is more common in the legs.
• Your vascular surgeon may order a blood flow test in your arms and
legs, such as an ultrasound exam, or an x ray, such as a venogram, to determine
whether your veins are large enough to qualify for a fistula.
• Sometimes a non-invasive arterial doppler test is used to evaluate the
flow in your arteries if this is a concern to your surgeon.
• Your vascular surgeon will give you the necessary instructions you
need to follow before the surgery, such as fasting. Usually, your physician will
ask you not to eat or drink anything 8 hours before your procedure.
• Your physician will discuss with you whether to reduce or stop any
medications that might increase your risk of bleeding or other complications.
• You will have the procedure on an outpatient basis.
• Most often, you will first be sedated and then your surgeon will numb
the area where the fistula or graft will go. In some cases, your
anesthesiologist may put you to sleep.
• Depending upon the quality of your artery and vein, your surgeon will
construct the fistula with one incision using the forearm of the arm that you do
not use as frequently. For example, if you're left handed, your physician will
place the fistula in your right arm, if possible.
• To perform the surgery, your physician joins an artery and a large
vein under the skin. The physician divides your vein and sews it to an opening
made in the side of the artery. As a result, blood flows into the veins that
lead back to your heart, and also down the arteries into the hand. The blood
normally traveling in your divided vein goes back to the heart through other
• If you cannot receive a fistula because the vein is
too small or blocked, your physician may construct a graft using a piece of
• Your physician sews the graft to one of your veins and connects the
other end to an artery. Your physician may place the graft material straight or
form a loop under the skin either in your lower arm, upper arm, or occasionally
in your leg.
What can I expect after dialysis access?
• After the operation, you should initially keep the access area raised
above your heart to reduce swelling and pain.
• Your surgeon may recommend an over-the-counter painkiller to relieve
pain, if necessary.
What can I do to keep my new access site working properly in the
weeks after the surgery?
• Keep the incision dry for at least 2 days after the procedure and do
not soak or scrub the incision until it has healed
• Avoid lifting more than about 15 pounds or other activities that
stress the access area, such as digging
• Report pain, swelling, or bleeding immediately to your physician,
especially if these symptoms are becoming worse. Some pain or swelling is common
and not worrisome if decreasing, but you should tell your physician if you have
bleeding or a fever higher than 101 degrees Fahrenheit
• You may feel some coolness or numbness in the hand with the fistula.
These sensations usually go away in a few weeks as your circulation compensates
for the fistula. However, if these sensations are severe or don’t disappear,
tell your physician as soon as possible, because the fistula may be causing too
much blood to flow away from your hand, a condition physicians call a
• You should perform exercises to grow and strengthen your fistula,
after the pain from the surgery decreases, to make dialysis faster and easier.
Your physician may recommend squeezing a soft object with the hand in the arm
with the fistula.
• Grafts mature more quickly than fistulas. They sometimes can be ready
in 2 to 3 weeks, but many physicians recommend waiting about 4 to 6 weeks before
using a graft.
• Grafts are more likely than fistulas to become infected. Grafts
usually last about 1 to 2 years, which is less than fistulas.
• Fistulas can often last up to 3 to 7 years. If you care properly for
your graft, however, you can help it last for many years.
• Sometimes portals can take weeks or even months until they are ready
for dialysis use. Until the portal is ready, you may have to use a catheter for
Are there any complications?
Complications with dialysis access include:
What can I do to keep my access site working properly?
Protecting the dialysis access is crucial for you. The following tips will
help you care for a fistula or a graft:
• Check several times each day to make sure the access is
• Monitor any bleeding after dialysis. If the graft seems to
bleed longer than usual from the needle sites, you should notify your dialysis
• Do not carry heavy items with the arm that has the
• Do not sleep on that arm
• Do not wear any clothing or
jewelry that binds that arm
• Do not let anyone draw blood or measure
blood pressure from that arm
• Do not allow injections to be given into
the fistula or graft
• Keep the site of the fistula or graft
• After dialysis, monitor the access for signs of infection, such
• Do not use any creams and lotions over the site of the
fistula or graft