At Saint Luke’s Hospital, we provide a multidisciplinary approach to managing your dialysis access needs. Our surgeons work closely with nephrology and are available to evaluate an existing dialysis access that may be causing you problems, such as pain, discomfort, or visible aneurysm formation.

We also work with a team of interventional radiologists to troubleshoot more immediate problems that are causing a delay in your hemodialysis treatments.

For more information, call our vascular access coordinator at 816-932-8311.

Creating a Hemodialysis Access

Creating a Hemodialysis Access

Before hemodialysis can be done, a way for blood to leave and return to your body (an access) is needed. During hemodialysis, needles placed into the access carry blood to and from the dialyzer. A hemodialysis access is often made in your arm. The 2 main types of accesses are an arteriovenous fistula (AV fistula) and an arteriovenous graft (AV graft).

Making your access

The hemodialysis access provides a large volume of fast flowing blood. It involves surgery under anesthesia. You may be able to go home the same day. It is made during a short procedure using 1 of these methods:

  • A fistula is made by linking an artery to a nearby vein. The high pressure and blood flow in the artery are transferred into the vein. They help the vein grow in size and thickness. The enlarged vein (fistula) eventually has high blood flow. It becomes thick enough for needles to be placed safely several times each week during hemodialysis. It may need weeks or months to develop before it's ready to be used. A fistula works better than the graft. It also has fewer long-term problems. It is the preferred form of access.

    Silhouette of hand and wrist showing fistula for hemodialysis. Inset shows blood flow through fistula.

  • A graft (piece of synthetic tube) may be sewn between an artery and a vein. It's often used if a fistula is not possible because of the small size of your veins. Blood flows quickly through the graft from the artery to the vein. A graft is often ready to use in a few weeks. Needles can be placed into the plastic tube to get blood during dialysis.

    Silhouette of hand and forearm showing graft for hemodialysis. Arrows show blood flow through graft.

Both types of access may take weeks to months before they can be used. If dialysis is needed right away, a short-term venous catheter is used. A catheter that allows two-way blood flow is placed into a large vein. The dialysis tubing is then connected to the catheter. If both the AV fistula and graft don't work, a more permanent venous catheter is used.

The most common complications for hemodialysis access are:

  • Infection
  • Clotting
  • Decreased blood flow from clotting or other narrowing

Arteriovenous (AV) Fistula for Dialysis

Arteriovenous (AV) Fistula for Dialysis

An AV fistula is a connection between an artery and a vein. For this procedure, an AV fistula is surgically made using an artery and a vein in your arm. (Your healthcare provider will let you know if another site is to be used.) When the artery and vein are joined, blood flow increases from the artery into the vein. As a result, the vein gets bigger over time. The enlarged vein provides easier access to the blood for a treatment for kidney failure (dialysis). This sheet explains the procedure and what to expect.

Forearm and hand showing vein and artery connected by stitches. Arrow shows blood flow going from artery to vein.

Getting ready for the procedure

Prepare as you have been told. Also:

  • Tell your healthcare provider about all the medicines you take. This includes all over-the-counter and prescription medicines. It also includes herbs, vitamins, and other supplements, as well as illegal drugs. You may need to stop taking some or all of them before the procedure.

  • Follow any directions you’re given for not eating or drinking before the procedure.

  • Do not let anyone draw blood from or take blood pressure on the arm that will have the fistula before the procedure.

The day of the procedure

The procedure takes about 1 to 2 hours. You’ll likely go home the same day.

Before the procedure starts:

  • An IV (intravenous) line is put into a vein in the arm or hand not being used for the procedure. This line gives fluids and medicines.

  • To keep you free of pain during the procedure, you may be given general anesthesia. This medicine lets you to sleep comfortably during the procedure. Another option would be to do a nerve block that numbs the arm. With it, you may also be given medicine that makes you relaxed and drowsy through the procedure.

During the procedure:

  • The skin over your arm may be injected with numbing medicine.

  • One or more small cuts (incisions) are then made through the numbed skin. This depends on the size of your arm and the depth of the vein in your arm.

  • The vein is attached to the selected artery.

  • Any cuts made are then closed with stitches (sutures), staples, surgical glue, or strips of surgical tape.

After the procedure:

  • You’ll be asked to keep your arm raised (elevated) as often as possible for at least 1 week after the procedure.

  • You’ll be given medicines for pain as needed.

  • Your arm and hand will be checked to make sure blood is flowing through the fistula properly. The feeling of blood rushing through the fistula is called a thrill. It is somewhat like the purring of a cat. You’ll be taught how to check for this feeling each day to make sure there are no problems with your fistula. You’ll also be taught how to care for your fistula at home.

  • When it’s time for you to leave the hospital, have an adult family member or friend ready to drive you home.

Recovering at home

Once at home, follow all the instructions you’ve been given. Be sure to:

  • Take all medicines as directed.

  • Care for your incision as instructed.

  • Check for signs of infection at the incision site (see below).

  • Don't do any heavy lifting and strenuous activities as directed.

  • Monitor and care for your fistula as instructed.

When to call your healthcare provider

Call your healthcare provider right away if any of these occur:

  • Fever of 100.4°F ( 38°C) or higher, or as advised by your provider

  • Signs of infection at the incision site, such as more redness or swelling, warmth, worsening pain, bleeding, or bad-smelling drainage

  • You can’t feel a thrill (the vibration of blood going through your arm)

  • Pain or numbness in your fingers, hand, or arm

  • Bleeding, redness, or warmth around your fistula

  • Sudden bulging of the fistula that is more than normal (a slight bulge is normal)


Your healthcare provider will check your fistula within 1 to 2 weeks after the procedure. It will likely take about 6 to 8 weeks for the fistula to get big enough to start dialysis. After that, make sure the fistula is checked each time you have dialysis. Your healthcare provider may also suggest checkups every 6 months.

Risks and possible complications

  • The fistula doesn't work right

  • Long wait before the fistula is ready (up to 6 months)

  • Coldness or numbness in the hand (due to blood flowing away from the hand and into the fistula)

  • An unsightly bump under the skin (due to enlargement of the fistula)

  • Prolonged bleeding from the fistula after dialysis

  • Narrowing or weakening of the blood vessels used for the fistula

  • Forming of blood clots in the blood vessels used for the fistula

  • Risks of anesthesia or any other medicines used during the procedure

Living with an AV fistula

A problem, such as a narrowing (stricture) of the vein or an infection, can make the fistula unusable. If this happens, you may need other treatments to fix or make a new fistula. To protect your fistula, follow these and any other guidelines you’re given:

  • Check your fistula as often as your healthcare provider says. If you can’t feel your thrill, let your provider know right away.

  • Make sure your fistula is checked before each dialysis treatment.

  • Don’t let anyone draw blood from or take blood pressure on the arm that has the fistula.

  • Wash your hands often and keep the area around your fistula clean.

  • Don’t sleep on the arm that has the fistula.

  • Don’t wear tight clothing, tight jewelry, or a watch on the arm with your fistula.

  • Protect your fistula from cuts, scrapes, or blows.

Caring for Your Hemodialysis Access

Caring for Your Hemodialysis Access

It's important to care for and protect your access to help it last. A problem such as an infection or a blood clot may make your access unusable. This may happen more often with an arteriovenous graft than with an arteriovenous fistula. If this occurs, you may need a new access. Follow these guidelines to help protect your access.

Watching for problems

Call your healthcare provider right away if you:

  • Can’t feel the blood flowing in the access (this sensation is called a thrill)

  • Have pain or numbness in your hand or arm

  • Have bleeding, redness, a bluish color, or warmth around your access

  • Notice your access suddenly bulging out more than usual (a slight bulge is normal)

  • Have a fever of 100.4°F (38°C) or higher, or as advised by your provider

Follow these and any other guidelines you’re given

  • Don’t wear tight clothes or jewelry around your access.

  • Don’t let anyone take your blood pressure on or draw blood from the arm with the access. Also don’t let anyone put IV (intravenous) lines into it.

  • Protect your access from being hit or cut.

  • Wash your hands often and keep the area around the access clean.

  • Do not carry anything heavy or do anything that would put pressure on the access.

Feeling for your thrill

If you put your fingers over your access, you should feel the blood rushing through it. This is called a thrill, and it feels like a vibration. Feel for the thrill as often as you're told, usually once or twice a day. If you can't feel it, tell your healthcare provider right away. Blood may not be flowing through your access the way it should.

Fingers resting on forearm to feel thrill in hemodialysis access.

Important numbers

Write the names and numbers of your healthcare providers below or have them programed into your cellphone. That way you will know how to get in touch with them.

Healthcare Provider:

Name ___________________ Phone ___________________


Name ___________________ Phone ___________________

Dialysis Center:

Name ___________________ Phone ___________________

How daily issues affect your health

Many things in your daily life impact your health. This can include transportation, money problems, housing, access to food, and child care. If you can’t get to medical appointments, you may not receive the care you need. When money is tight, it may be difficult to pay for medicines. And living far from a grocery store can make it hard to buy healthy food.

If you have concerns in any of these or other areas, talk with your healthcare team. They may know of local resources to assist you. Or they may have a staff person who can help.