Vascular Access for Dialysis

Possible complications include:

• Infection
• Blood clots or thrombosis
• Narrowing of the blood vessel (stenosis)
• Reduced blood flow
• Bleeding
• Swelling of the arm
• Aneurysm or pseudoaneurysm
• Catheter dysfunction
• Problems with blood flow during dialysis
• Hand or limb circulation problems in some patients

The National Kidney Foundation's KDOQI resources emphasise regular monitoring and management of access problems, including stenosis, thrombosis, infection, aneurysm, and access-related hand ischaemia.

How Can Patients Care for Their Dialysis Access?

Good access care is important for maintaining its function and reducing complications.

Patients with an AV fistula or graft should:

• Check the access regularly for changes.
• Follow the dialysis team's instructions regarding cannulation and care.
• Avoid unnecessary pressure or injury to the access arm.
• Inform the healthcare team about swelling, redness, pain, or bleeding.
• Report changes in the usual vibration or "thrill" of the fistula or graft.
• Follow all prescribed dialysis and follow-up appointments.

Patients with a dialysis catheter need particularly careful infection prevention. The catheter site should be monitored for redness, discharge, pain, fever, or other signs of infection. Proper infection-control practices are essential whenever the catheter is accessed.

Patients should also tell healthcare professionals that they have a dialysis access. Blood pressure measurements, blood draws, or intravenous procedures on an access arm may need to be avoided or carefully planned according to the treating team's instructions.

When Should You Seek Medical Attention?

Contact the dialysis team or doctor promptly if there is:

• Sudden loss of the normal thrill or vibration over an AV fistula
• Significant swelling
• Persistent bleeding
• Increasing pain or redness
• Pus or discharge
• Fever or chills
• Coldness, numbness, or unusual colour changes in the hand
• Repeated difficulty with cannulation
• Poor blood flow during dialysis
• Catheter damage or accidental displacement