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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Dialysis access

In short

Dialysis needs a way in. For hemodialysis, that is a fistula (your own artery joined to a vein in your arm), a graft (a soft tube joining them) or a catheter (a tube in a large vein in the neck or chest). For peritoneal dialysis (PD), it is a soft tube into your belly. For most people on hemodialysis, a fistula is the best long-term choice: it lasts longer and gets fewer infections, but it can take months to be ready (NKF; NIDDK). So plan early, protect the veins in your arms from stage G3 on, and check your access every day.

Your numbers

Access Ready to use Infection risk Source
Fistula Weeks to several months; your team checks how it is growing about 4–6 weeks after surgery Lowest NIDDK; KDOQI 10.1
Graft Often soon after surgery Higher than a fistula; more clotting NIDDK; NKF
Catheter (tunneled under the skin) Right away Highest; meant as a bridge when possible KDOQI 2.3, 2.6, 2.10
PD catheter Placed at least 2 weeks before PD is needed; works best after 10–20 days of healing Exit-site infection and peritonitis KDOQI 6.8; NIDDK

When to plan: KDOQI suggests referral for an access when your eGFR is 15–20, or sooner if it is falling fast (more than 10 a year) (KDOQI, statement 6.6).

If an access bleeds: press firmly for at least 10 minutes before you check. If it is still bleeding after 10–15 minutes, starts again, or is heavy or spurting, keep pressing and call 911 (AKF; NKF).

Protect your veins (from stage G3)

A fistula needs healthy veins. KDOQI advises protecting the veins and arteries in both arms when dialysis may be needed later. That means avoiding PICC lines (long IV lines put in through the arm) and any needle stick that is not needed (KDOQI, statement 6.10).

  • Ask your kidney team which arm may be used for a future access.
  • Say "I have kidney disease; please save my veins" before blood tests, drips and IVs. NIDDK suggests asking for a vein in the back of your hand (NIDDK).
  • Ask staff to use the other arm, and ask for a different line if someone suggests a PICC.
  • Tell any doctor planning a heart procedure or a pacemaker that you may need a fistula; KDOQI lists these as other ways veins and arteries can be damaged (KDOQI, statement 6.10).

What to do: daily care

Fistula or graft

  • Feel the buzz (thrill) every day, and again if something feels different. Call your unit right away if it stops, feels much weaker or changes (NKF).
  • Wash the access with soap and warm water every day and before each treatment (NIDDK; NKF).
  • Look for redness, warmth, swelling, pain or drainage (NKF).
  • No blood pressure cuff on the access arm, and no blood draws or IVs in it unless your dialysis team says it is okay (NKF).
  • No tight sleeves, watches or bracelets over the access; do not sleep on that arm; do not carry heavy bags on it (NKF).
  • If your team suggests exercises to help a new fistula grow, do the whole-arm exercises they show you, not finger exercises alone (KDOQI, statement 10.3).
  • Keep clean gauze and tape at home in case of bleeding (AKF).

Hemodialysis catheter

  • Follow your unit's rules for the dressing, showering and swimming. Ask before you get it wet, and tell the unit right away if the dressing gets wet, loose or dirty or comes off (NKF).
  • Only dialysis staff should open or use the catheter. Never open the caps yourself.
  • Fever, chills, or redness, swelling or drainage at the exit site means call your unit right away, not at your next session: catheters carry the highest infection risk. With shaking chills, confusion or a racing heart, call 911 (NKF; Get help now).
  • Ask your team when a fistula or graft can replace it (KDOQI, statement 2.6).

PD catheter

  • Clean the exit site every day the way your PD nurse showed you (NIDDK).
  • Wash your hands every time you touch the catheter (NIDDK).
  • Cloudy fluid, belly pain or fever: call your PD unit the same day and keep the bag, so the fluid can be tested (ISPD 2022).
  • Ask your PD unit before swimming, baths or hot tubs; rules differ between units.

Examples

Planning ahead. Your eGFR has gone from 24 to 19 in a year. Your team refers you to a surgeon, who maps your veins and makes a fistula in your left forearm. At 6 weeks the team checks it (KDOQI, 10.1). When you start dialysis 5 months later, it is ready, and you avoid a catheter.

The morning check. Each morning you rest two fingers on your fistula. You feel a steady buzz, like a purring cat. One day it is gone. You call the unit at once instead of waiting for your next session (NKF).

A bleed at home. After dialysis, your needle site starts bleeding at home. You sit down, press firmly on gauze with two fingers, and do not peek for 10 minutes. It has stopped. If it had not stopped after 10–15 minutes, or started again, you would keep pressing and call 911 (AKF).

Your rights in a US dialysis unit. The care team must check your access and refer you for a new one in good time; this is part of your written plan of care (42 CFR 494.90).

Ask your care team

  1. Which arm should I protect, and when should I see an access surgeon?
  2. Am I a good candidate for a fistula? If not, why?
  3. How will we know my fistula is ready? What happens if it does not grow?
  4. If I start with a catheter, when can it come out?
  5. If I choose PD, when will the catheter go in, and how long must it heal?
  6. What should I do if my access bleeds, swells or the buzz changes?

Get help now if…

Call 911 (or your local emergency number)

Bleeding from a fistula or graft that is heavy, spurting, or has not stopped after 10–15 minutes of firm pressure: keep pressing while you call (AKF; NKF). Also chest pain, severe breathlessness, or fever with confusion, shaking chills or a racing heart. Full list: Get help now.

Call your dialysis or PD unit right away (do not wait for your next session)

No buzz in your fistula or graft; redness, warmth, pus or pain at an access or exit site; fever or chills with a catheter; a catheter that moves, cracks, leaks or comes out; cloudy PD fluid (keep the bag) (NKF; ISPD 2022).

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.