Why do you need vascular access?

Hemodialysis removes blood from your body, filters it through a machine, and returns it — several hundred times during a single session. To do this efficiently, the dialysis machine needs access to a large volume of blood flowing quickly. Regular veins and arteries in the arm are too small and fragile for this — so a special access point needs to be created or inserted.

There are three types of vascular access, and which one is right for you depends on your blood vessels, your health, and how urgently you need dialysis.

AV fistula — the gold standard

An arteriovenous (AV) fistula is created by a vascular surgeon who connects an artery directly to a nearby vein — usually in your forearm or upper arm. Because arteries carry blood at high pressure, connecting one to a vein causes the vein to expand and thicken over time. This creates a large, durable vessel that can handle the demands of dialysis for years or even decades.

Why it's preferred

  • Longest lasting of all access types — often 10–20+ years
  • Lowest risk of infection and clotting
  • Best blood flow rates = most effective dialysis
  • No foreign material in your body

The catch — planning ahead

An AV fistula takes 2–3 months to "mature" (grow large enough) before it can be used. This is why your nephrologist will refer you for fistula evaluation in Stage 4 — well before you actually need dialysis. Waiting until your kidneys fail means using a catheter as a bridge, which carries higher risks.

The "Fistula First" initiative is a national campaign encouraging fistula use as the preferred dialysis access. Ask your nephrologist about fistula evaluation if you're approaching Stage 4.

AV graft

When your own blood vessels aren't suitable for a fistula — due to small vein size, previous damage, or other factors — a graft is an alternative. A surgeon places a soft synthetic tube (usually made of PTFE, a medical-grade material) connecting an artery to a vein under the skin.

Grafts can be used sooner than fistulas (usually within 2–4 weeks), but they tend to have higher rates of clotting and infection than fistulas, and they typically don't last as long.

Central venous catheter

A catheter is a soft flexible tube inserted through the skin into a large vein in the neck (jugular), chest (subclavian), or groin (femoral). It can be used for dialysis immediately — no waiting period.

Catheters are used as a bridge when someone needs dialysis urgently and doesn't have a permanent access ready. They are not meant for long-term use because they have significantly higher rates of:

  • Serious bloodstream infections (bacteremia/sepsis)
  • Clotting
  • Poor blood flow rates (less effective dialysis)
  • Vessel scarring
If you have a catheter, protect it carefully. Keep it dry, never let anyone draw blood or give IV fluids through it other than your dialysis team, and report any redness, discharge, or fever immediately — these can be signs of a life-threatening infection.

Caring for your fistula or graft

  • Feel for the "thrill" (vibration) daily — if you can't feel it, call your care team immediately as this may mean a clot
  • Never let anyone take blood pressure or draw blood from your access arm
  • Don't sleep on your access arm or wear tight clothing or watches over it
  • Keep the skin clean and moisturized
  • Report any swelling, redness, warmth, or pain promptly
  • Squeeze a soft ball or exercise the access arm gently to promote blood flow (ask your care team first)