Hemodialysis requires reliable access to the bloodstream. This is called vascular access or dialysis access. Common access types include an arteriovenous fistula, a graft, and a dialysis catheter such as a permcath.
What is an AV fistula?
An AV fistula is created by connecting an artery and a vein, usually in the arm. After it matures, it can provide the high blood flow needed for hemodialysis. When suitable, fistulas are often preferred because they generally have lower infection and clotting risks and can last longer than catheters.
What is a permcath?
A permcath is a tunneled dialysis catheter placed into a large central vein. It can be used immediately, which makes it useful when dialysis must start before a fistula is ready or when a fistula is not possible. Catheters carry important infection and clotting risks, so careful handling is essential.
How should a fistula be checked?
Your dialysis team may teach you to feel for the normal vibration, often called a thrill. A sudden change or loss of the thrill, increasing redness, warmth, swelling, bleeding or pain should be reported promptly.
How should a catheter be protected?
Keep the dressing clean and dry, do not open or manipulate catheter caps yourself unless specifically trained, and report fever, chills, drainage, redness or tenderness around the catheter. Catheter care instructions from your dialysis unit should always take priority.
Plan access early when possible
For patients approaching kidney failure, early vascular assessment can reduce the chance of needing an emergency catheter. Access choice and timing depend on blood vessels, expected dialysis needs, other medical conditions and the patient’s overall treatment plan.
Trusted patient education sources
This guide is written in patient-friendly language using established kidney education principles from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and, for dialysis access, the National Kidney Foundation. It is not a substitute for personal medical advice.