Last updated: August 20, 2026
Medically reviewed by: NKF Patient Education Team
Hemodialysis access is the place where blood leaves and returns to your body during hemodialysis. Access types include fistula, graft, and catheter. Good access care can lower the chance of infection, bleeding, or clotting.
Table of Contents
- About hemodialysis access
- How hemodialysis access works
- Types of hemodialysis access
- Choosing the right access
- Getting ready for access surgery or placement
- Caring for your access
- Checking your access each day
- Keeping your access working well
- Safety and when to call right away
- If access problems happen
- Daily life with hemodialysis access
- Questions to ask your dialysis care team
- Kidney health information, support, and professional resources
Your dialysis access is your lifeline for hemodialysis. Checking it every day and reporting changes early can help prevent serious problems.
How hemodialysis access works
During hemodialysis, blood moves from your body through soft tubes to the dialysis machine. The machine cleans the blood and sends it back to your body.
If you have a fistula or graft, two needles are placed into the access at each treatment. One needle sends blood to the machine. The other needle returns cleaned blood to your body.
If you have a catheter, the dialysis tubes connect to the catheter. Needles are not used with a catheter.
Types of hemodialysis access
Fistula
A fistula is made by connecting an artery and a vein, usually in your arm. It uses your own blood vessels.
What to know: A fistula often lasts longer and has fewer infections than other access types. It needs time to heal and grow stronger before it can be used. This may take weeks to months.
Graft
A graft is a soft tube placed under the skin to connect an artery and a vein, usually in your arm.
What to know: A graft may be used when a fistula is not possible. It can often be used sooner than a fistula, but it may have a higher chance of infection or clotting.
Catheter
A catheter is a tube placed into a large vein, often in the neck or chest.
What to know: A catheter can often be used right away. It may be used when dialysis needs to start quickly or while a fistula or graft is healing. Catheters have a higher risk of infection and may not work as well for long-term dialysis. When possible, your care team may plan for a fistula or graft instead of using a catheter long term.
Choosing the right access
The best access depends on your body, your health, and how soon you need dialysis. Your doctor and dialysis care team will look at your blood vessels, treatment plan, and personal goals. Your care team may use an ultrasound to look at your blood vessels before choosing an access.
Ask about your options as early as possible. A fistula or graft may need time to heal before it can be used for dialysis.
Planning early may lower the chance that you need a catheter to start dialysis.
Getting ready for access surgery or placement
Before a fistula or graft is placed, your care team may check the blood vessels in your arms. This may be done with an ultrasound. The test helps your care team choose the safest place for your access.
Your care team may tell you to protect one arm before surgery. This is sometimes called “saving the arm” for dialysis access.
If your care team tells you to save one arm:
- Do not let anyone take blood pressure on that arm.
- Do not let anyone draw blood from that arm unless your care team says it is okay.
- Do not let anyone place an IV in that arm unless your care team says it is okay.
- Tell doctors, nurses, and emergency staff that the arm is being saved for dialysis access.
Before your access surgery or placement, ask:
- Which arm will be used?
- When can my access be used for dialysis?
- How should I care for the area after surgery or placement?
- What problems should I watch for?
- Who should I call if I have pain, swelling, bleeding, or signs of infection?
Caring for your access
Fistula or graft care
These steps can help lower the chance of infection, bleeding, or clotting.
- Wash your hands and access area with soap and water before each dialysis treatment.
- Do not scratch your access or pick at scabs.
- Look for redness, warmth, swelling, pain, drainage, or bleeding.
- Ask your dialysis team to rotate needle sites when possible.
- After dialysis, use only gentle pressure where the needles were removed. Too much pressure can slow or stop blood flow through the access.
Catheter care
A catheter needs special care because it has a higher chance of infection.
- Keep the catheter dressing clean and dry.
- Do not open the catheter caps.
- Do not pull, twist, or tug on the catheter.
- Ask your dialysis team how to bathe or shower safely with a catheter.
- Tell your dialysis team right away if the dressing gets wet, loose, dirty, or comes off.
Never open your catheter or remove the caps on your own. This can let germs enter your bloodstream.
Checking your access each day
Your dialysis team will show you how to check your access at home. Ask them to watch you practice so you know you are doing it correctly.
Check a fistula or graft
- Feel for a vibration or buzzing over the access. This is often called a thrill.
- Look for redness, warmth, swelling, pain, drainage, or bleeding.
- Notice if the access feels different than usual.
- Call right away if: the buzzing stops, feels much weaker, or changes from what is normal for you.
- Do not wait until your next dialysis treatment to report this.
Check a catheter
- Make sure the dressing is clean, dry, and firmly in place.
- Look for redness, swelling, drainage, pain, or bleeding near the catheter.
- Call your dialysis team if the dressing gets wet, loose, dirty, or comes off.
- Tell your dialysis team if you have fever, chills, or feel sick after dialysis.
Keeping your access working well
Small daily steps can help protect your access.
- Do not wear tight sleeves, watches, bracelets, or jewelry over your access.
- Do not sleep on your access arm.
- Do not carry heavy bags or put heavy pressure on your access arm.
- Do not let anyone use a blood pressure cuff on your access arm.
- Do not let anyone draw blood or place an IV in your access arm unless your dialysis team says it is okay.
- Keep all dialysis and follow-up appointments so your care team can check your access.
Safety and when to call right away
Access problems can become serious quickly. Call your dialysis center, doctor, or emergency services right away if you have:
- Bleeding that will not stop
- Heavy bleeding or blood that is spurting from your access
- Fever or chills
- Redness, warmth, swelling, pain, or drainage near your access
- A fistula or graft that stops buzzing or vibrating like usual
- A catheter dressing that is wet, loose, dirty, or comes off
- A catheter that moves, cracks, leaks, or comes out
- Chest pain, trouble breathing, fainting, or severe weakness
Use clean gauze or a clean towel and apply steady pressure. If bleeding is heavy, spurting, or does not stop, get medical help right away.
If access problems happen
- Even with good care, an access can sometimes clot, narrow, bleed, or become infected.
- Your dialysis team may order tests or send you for a procedure to fix the access. Some access problems can be treated without staying overnight in the hospital.
- Do not wait to report a problem. Early treatment may help keep your access working.
Daily life with hemodialysis access
Bathing and showering
- Ask your dialysis team what is safe for your access type. A healed fistula or graft may have different care instructions than a catheter.
- If you have a catheter, ask how to keep the dressing dry and protected.
- Do not swim or soak in a bath with a catheter unless your dialysis team says it is safe.
Work, exercise, and daily activities
Many people can work, exercise, and do daily activities with dialysis access. Ask your care team what activities are safe for you. If your job or activity involves lifting, pressure on your arm, or contact sports, ask how to protect your access.
Needles and pain
If you have a fistula or graft, needles are used for hemodialysis. Tell your dialysis team if needle placement is painful or stressful. They can talk with you about comfort options and needle site rotation.
Questions to ask your dialysis care team
- What type of access do I have?
- Is my access temporary or long term?
- How do I check my access at home?
- What is normal for my access, and what changes should I report?
- What should I do if my access starts bleeding?
- Can I shower or bathe with my access?
- Are there activities I should avoid?
- Who should I call after hours if I have an access problem?
- Can I switch from a catheter to a fistula or graft?
- When should I see a vascular access surgeon or specialist?
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