Hemodialysis Access: Catheter, Fistula, Graft

Hemodialysis needs a reliable way to move blood in and out. You’ll hear about three options: a catheter (temporary), a fistula (preferred long-term), or a graft (when veins aren’t ideal). Peritoneal dialysis uses a different access (abdominal catheter) and isn’t covered here.

Quick compare

Catheter (neck/chest): fastest to use; highest infection/clot risk; for urgent starts or while a permanent access heals.
Fistula (AVF): artery joined to a vein in the arm; lowest infection risk; can last years; takes time to “mature.”
Graft (AVG): soft synthetic tube joining artery to vein; ready sooner than a fistula; more stenosis/infection than AVF.

Catheters

Flexible tubes placed in a large vein (often chest). Common when dialysis must start now. Some are temporary (ICU/neck); most outpatient lines are tunneled with cuffs to reduce infection.

Pros: can use immediately; no needles.
Cons: higher infection and clot risk; lower blood flows; can limit showers and activities.
Care: keep dressing clean/dry; no submerging (pools, tubs); avoid tugging; never flush at home.
Goal: plan a fistula or graft ASAP so the catheter can be removed.

Fistulas (AVF)

A small outpatient surgery connects an artery to a vein—usually in the forearm or upper arm. Over weeks, the vein gets thicker and easier to use.

Timeline: often 6–12 weeks to mature (varies). Your team will check size/flow before first cannulation.
Daily check: feel a gentle vibration (thrill) over the fistula. Call if it’s weak or gone.
Protect the arm: no blood pressure, IVs, tight watches/jewelry, or heavy lifting until cleared.
During treatment: needle techniques include rope-ladder or buttonhole (center policy varies).
Watch for: prolonged bleeding after needle removal, bulging areas that keep growing, numb/cold fingers, hand pain with use.

Grafts (AVG)

A soft synthetic tube connects an artery to a vein—useful when veins are too small/damaged for a fistula.

Timeline: often ready in ~2–4 weeks (surgeon confirms).
Care: same arm protections as a fistula; avoid pressure over the graft.
Watch for: redness, warmth, tender lumps, prolonged bleeding, or new high-pitched “whistling” sound (may signal narrowing).

Choosing & timeline

Urgent start: catheter now, plan fistula (first choice) or graft as soon as possible.
Planned start: vein mapping ultrasound → fistula if feasible; graft if not.
After creation: you may get hand/forearm exercises to help a fistula mature—follow your surgeon’s guidance.

Access care basics

Keep skin clean; follow dressing instructions. Don’t scratch scabs at needle sites.
Warm the arm before cannulation (per clinic routine) to help veins open up.
After treatment, hold gentle pressure—don’t peek. Report bleeding that won’t stop.
Sleep with the access arm uncrowded—no body weight on it; avoid tight sleeves.

When to call

Right away: fever/chills, spreading redness, pus, foul odor, or sudden loss of thrill (fistula/graft).
Soon: new severe hand pain, cold/numb fingers, prolonged bleeding (>20 minutes), swelling that’s getting worse, or a catheter dressing that gets soaked or pulled loose.

Questions to ask: Which access is best for me and why? What’s my target timeline? How will we check if the fistula/graft is ready? What are my “call now” signs?

Educational only. Your surgeon and dialysis team will tailor access choice and care to you.