Dialysis Access Care: Your Lifeline, Protected

The access hierarchy

Fistulas (native vessels) are the gold standard: lowest infection, clotting, and death rates. Grafts (synthetic bridges) sit second, and catheters — the quickest to place — carry the highest infection and mortality risk, which is why catheters are meant to be temporary bridges to a working fistula.

The patient's job is to make the fistula the default: care for the arm, build the fistula with exercise, and resist 'let's just use a line' whenever a fistula could be developing.

The daily routine

Every day: check for thrill (vibration you can feel), check the skin over the access (no redness, heat, tenderness, or swelling), and wash the arm. Before each session: wash with soap and water. After sessions: keep the dressing clean, avoid heavy lifting that day, and let bleeding sites clot fully before leaving the center.

Catheter care: never get the dressing wet; shower with a waterproof cover (no baths, no swimming); watch the exit site for discharge; and treat fever or chills as a catheter infection until proven otherwise.

When to call

Call immediately for: fever or chills (catheter patients especially), redness, warmth, pus, or pain at the access site, an absent thrill, new arm swelling, bleeding that won't stop with pressure, or a cold pale hand. Every hour matters with access emergencies — early intervention salvages access; delay converts it to a new surgery.