Reliable long-term access
Individualized planning, creation and maintenance of a reliable vascular access—designed around the patient’s dialysis pathway, vessel anatomy and long-term needs.
A lifeline for haemodialysis
A vascular access allows blood to travel safely between the patient and the dialysis machine. Planning considers the full kidney-replacement pathway—not only the next procedure—so current needs, future options and the patient’s vessels are protected whenever possible.
Access options
A direct surgical connection between an artery and a vein. When it suits the patient’s anatomy and long-term treatment plan, an AV fistula can provide durable access with a lower risk of infection and clotting than a dialysis catheter.
A biocompatible graft connects an artery and a vein when the patient’s own veins are not suitable for a fistula or when another access strategy is more appropriate.
A catheter placed in a large central vein can provide immediate access when dialysis must begin urgently or while a fistula or graft is maturing. It may also be considered when other access options are unsuitable.
Long-term intravenous access for medication or infusion therapy can also be assessed. Device selection is coordinated with the treatment team while preserving veins that may be important for future dialysis access.
Preoperative assessment
Assessment is coordinated with the kidney-care team and tailored to the patient’s treatment plan.
The access history, dialysis pathway, medical risks and patient priorities are reviewed.
Ultrasound evaluates arterial inflow and the size, course, depth and quality of potential veins without radiation.
Fistula, graft or catheter options are considered according to anatomy, timing, expected use and the patient’s overall life plan.
Physical examination, dialysis findings and targeted imaging help identify maturation failure, stenosis, thrombosis, infection, aneurysm, hand ischaemia or excessive flow.
Access protection
Follow the individualized instructions from your dialysis team. Preserve the planned access arm and report changes promptly rather than waiting for the next routine appointment.
Know the normal thrill of your fistula or graft
Keep the access and catheter dressing clean and dry
Avoid tight clothing, pressure and injury to the access arm
Do not allow routine blood pressure cuffs or blood draws on the access arm
Attend scheduled access and dialysis reviews
Report reduced flow, prolonged bleeding, pain or swelling early
Treatment journey
The dialysis pathway, vessel preservation and the patient’s priorities are reviewed with the nephrology and dialysis teams.
Arteries and veins are assessed to identify the safest and most durable access option.
The selected procedure is performed with careful attention to blood flow, future access options and the patient’s overall condition.
Healing, maturation and access function are monitored. Problems are addressed early to preserve reliable dialysis treatment.
Frequently asked questions
Your nephrologist, dialysis team and vascular specialist work together to match the access plan to your individual needs.
There is no single best access for every patient. The choice depends on the kidney-replacement plan, vessel anatomy, expected timing of dialysis, previous procedures, medical risks and personal priorities.
Duplex ultrasound assesses the size, course and quality of arteries and veins. It helps select a suitable site and supports an individualized surgical plan.
Maturation varies. The fistula must heal and develop enough flow and size for safe needle access. Clinical and ultrasound review determines when it is ready rather than time alone.
A fistula connects the patient’s own artery and vein. A graft uses a biocompatible conduit between them. Each has different advantages, timing and risks that must be matched to the individual patient.
A catheter is commonly used when dialysis must start before a fistula or graft is available. It may also be used when other options are not feasible, but it requires careful infection prevention and monitoring.
Often, yes. Early assessment can identify narrowing, thrombosis, maturation problems or other complications that may be treated with endovascular or surgical revision.
Learn the normal vibration or ‘thrill’ of your access, protect the arm from pressure or injury and report any important change. Follow the specific instructions given by your dialysis team.
When to seek assessment
The information on this page is intended for general patient education and does not replace an individual medical examination, diagnosis or treatment recommendation. Access selection and procedure availability depend on the clinical indication, the kidney-care plan and the treating hospital.
