Dialysis Access – Frequently Asked Questions

Dialysis access is a surgically created entry point that allows blood to be safely removed, filtered, and returned to the body during hemodialysis. It is essential for patients with end-stage kidney disease (ESKD) who need dialysis to remove waste, toxins, and excess fluids from the blood when the kidneys are no longer functioning properly.

There are three main types of dialysis access:

• Arteriovenous Fistula (AVF) – A connection between an artery and a vein, typically in the arm. It is the preferred type due to its durability and lower risk of infection.
• Arteriovenous Graft (AVG) – A synthetic tube connecting an artery to a vein. Used when veins are not suitable (eg too small in calibre) for an AV fistula.
• Central Venous Catheter (CVC) – A temporary tube placed in a large vein in the neck, chest, or groin. Used for short-term dialysis or when permanent access is not yet available.

The AVF is considered the gold standard because it:

✔ Provides better blood flow, leading to more effective dialysis.
✔ Has a lower risk of infection compared to other types.
✔ Lasts longer than AV grafts and catheters.

However, not all patients are suitable for an AVF. In such cases, an AVG or CVC may be necessary.

A vascular surgeon creates the access through a minor surgical procedure, typically under local or regional anaesthesia. The exact procedure depends on the type of access planned:

• AV fistula/graft: Created under the skin in the arm or forearm
• CVC: Inserted into a large vein in the neck or chest

• AV Fistula: 6–12 weeks to mature before it can be used
• AV Graft: 2–4 weeks before use
• CVC: Can be used immediately but has a higher risk of long term complications

Potential complications include:

⚠ Infection – more common with CVCs

⚠ Clotting or blockage – can reduce dialysis effectiveness

⚠ Narrowing (stenosis) – can restrict blood flow, leading to ineffective dialysis

⚠ Aneurysm formation – bulging at the access site.

⚠ Steal syndrome – situation where too much blood is diverted away from the hand to the fistula or graft, causing hand coldness, numbness, pain, or weakness

Regular monitoring and proper care can help prevent these complications.

• Keep the area clean
• Check daily for signs of infection (redness, swelling, warmth, discharge)
• Avoid excessively heavy lifting or pressure on the access arm
• Try to avoid sleeping on the arm with the fistula or graft
• Monitor blood flow during dialysis- also report changes like a weak pulse or cold fingers.

❌ No blood pressure checks, IV lines, or blood draws from the access arm.

❌ Avoid tight clothing or jewellery that may restrict blood flow.

❌ Do not sleep on the access arm.

❌ For CVC patients: Avoid submerging it in water – use waterproof coverings when bathing.

Seek medical attention if you experience:
🚨 Pain, redness, or swelling at the access site
🚨 Bleeding that does not stop after dialysis
🚨 Weak or absent pulse at the fistula/graft site
🚨 Fever or chills, which may indicate infection

If you need a dialysis access procedure or are experiencing complications, we’re here to help.

📍 Visit: Novena Vascular & Varicose Vein Centre. 38 Irrawaddy Rd, #08-48, Singapore 329563
📞 Call or drop a message on WhatsApp: (+65) 9727-0788
📧 Email: contact@drdarryllim.com
🌐 Website: https://drdarryllim.com