Placement of Vascular Access for Hemodialysis
This handout explains access the type of access used for dialysis and what to expect.
Hemodialysis is a process that removes
waste from the blood via a vein and
artery. Surgery is used to allow this to
occur in one of two ways.
ξ Fistula. A fistula is a connection
between an artery and vein that
helps the vein get high blood flow
from the artery. During dialysis,
lines are placed in the vein to clean
ξ Graft. A graft is made of a thin,
hollow, tube that is placed under
the skin to connect an artery and
vein. In this case, lines are placed
in the graft for dialysis.
Why access is needed
1. You are not currently on dialysis,
but your kidney doctor feels you
may need it in the near future, and
wants to be ready.
2. You currently get dialysis with a
catheter, but your kidney doctor
thinks it is time for a more
permanent option. This access will
allow you to get better dialysis
then the catheter can provide.
3. You have a fistula or graft but it
does not work well. Your kidney
doctor may either the current
access to be changed or new access
*Usually, new access cannot be used
right away. You must wait 3-14 days
after a graft is placed and 2 weeks – 2
months (can be longer) for a fistula to be
used for dialysis.
If your kidneys do not work, you need
dialysis, which requires some type of
access to clean and filter your blood. A
tunneled catheter can be put in the big
vein in your neck and used for dialysis,
but there is a higher risk of infection
compared to a fistula or graft. Patients
with a catheter have a higher risk of
death than patients with fistulas or
grafts. In most cases, your kidney doctor
will advise you to have a fistula or graft
so they can take the catheter out.
Often, these surgeries do not require you
to stay in the hospital overnight. You
show up 1-2 hours before your surgery
and go home about two hours after. You
may have a regional nerve block before
your surgery that makes your whole arm
numb, or get a local numbing medicine
during surgery. The anesthesia doctor
will also give you medicine to help you
relax. Surgery takes 1-2 hours, but can
How to prepare for your surgery
1. You may follow your normal diet
the day before surgery.
2. Do not eat or drink anything after
midnight the night before surgery.
3. Do not eat or drink the day of
surgery. You may take your
medicines with a sip of water,
unless told otherwise.
4. Your surgeon will advise you on
blood thinners such as Coumadin,
Plavix or Rivaroxaban. Do not stop
taking aspirin - you may keep
taking aspirin up to and after the
surgery. If you have diabetes, you
will get specific orders about your
diabetes medicine. Your surgeon or
the health care team may give you
orders about other medicines as
1. Failure of the fistula or graft to
work correctly. The most
common problem is that the fistula
or graft fails and is not able to be
used for dialysis. This happens
about 20-50% of the time and
depends on the type of surgery you
2. Long term failure of the access.
Many fistulas and grafts will start
to narrow or clot off completely
over time. This can happen months
to years after placement and
treatment is needed to keep them
3. Poor blood flow to your hand
after surgery. (Rare). Call your
surgeon right away if you have: a
lot of pain or your hand is very
cold, numb, or you cannot move it.
This may mean you do not have
enough blood flow to your hand. If
you have any concerns about this
go to the Emergency Department.
If you had a nerve block for your
surgery, this may mask signs of
poor blood flow. The nerve block
often lasts 6-12 hours.
4. Chronic poor blood flow to
hand. In about 1 in 20 cases, the
access works too well. This takes
too much blood away from the
hand and is called “steal
syndrome” because blood is
“stolen” from the hand to go into
the access. If your hand or arm feel
cold, numb, are in a lot of pain or
you have wounds that won’t heal
on your fingers, call your kidney
doctor or surgeon. This should be
5. Major heart complications.
People with kidney failure often
have other medical problems.
These include heart disease,
peripheral vascular disease, high
blood pressure and diabetes. These
other medical problems put you at
more of a risk for heart attacks and
death after any surgery. While we
believe the risk of major problems
such as heart attack and death is
low, it does exist.
6. Infection. There is a risk for
wound infection after any surgery.
If you have more redness,
swelling, or pain after the surgery,
call your surgeon.
7. Nerve injury. The area that we
have to cut to do the surgery
contains nerves that provide
feeling to the hand and forearm.
We try to avoid these nerves, but
they may get hurt during the
surgery. This could leave you with
numbness in the thumb or forearm.
This numbness usually improves,
but sometimes it never goes away.
8. Swelling. It is not uncommon to
have forearm swelling after
surgery. This should improve over
time and by elevating your arm.
Call your surgeon if you have
concerns about the swelling.
9. Unexpected findings. Sometimes
we have to stop the surgery
because we find something
unexpected. This could include
poor arteries or veins that would
not be good enough for surgery or
a concern about poor blood flow to
The day of the surgery is a "lost day."
You may feel a little “out-of-it” the day
after surgery as well. A few days after
surgery you should feel back to normal.
You may have some pain after surgery.
You will get a prescription for pain pills
Returning to activities.
If you work, plan to be off for about a
week. If you need more time off, let your
health care team know and we will fill
out the needed paperwork to be off
longer. If you feel well, you may return
to exercise in 2-3 weeks.
Call your surgeon if you have:
ξ Fever over 101 degrees F (39 C)
ξ More swelling
ξ Pain that is not helped by medicines
ξ Numbness, loss of movement, or
blue color in your hand
ξ Pus drainage from your wound
ξ Increased redness around your
ξ You are unable to eat or drink
If we need to see you after business
hours, or you need to come into the
hospital, we will send you to the
Roles within your health care team.
UW Health is a teaching hospital.
Surgeons work with residents and
medical students who will likely be
involved in your surgery. The attending
doctor will be in the operating room,
scrubbed in, and doing the surgery with
them. He/she will make all of the
decisions. The residents often close the
skin incisions by themselves. Students
are there to watch and learn about the
reasons for the surgery.
You will have a follow up visit with
your surgeon 2-4 weeks after surgery.
Your health care team may have given you this information as part of your care. If so, please use it and call
if you have any questions. If this information was not given to you as part of your care, please check with
your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical
condition. Because each person’s health needs are different, you should talk with your doctor or others on
your health care team when using this information. If you have an emergency, please call 911. Copyright ©
7/2016 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the
Department of Nursing HF#7916.