Patient Teaching Tools for Dialysis Patients to Care for Their Vascular Access

A well-functioning Vascular Access (Fistula or Graft) is vital to obtain adequate cleaning of blood and removal of fluid and waste products during hemodialysis treatments. The Vascular Access (Fistula or Graft) is the critically important connection between the patient’s blood stream and the hemodialysis machine.

Vascular Access (Fistula or Graft) is created when a vascular surgeon surgically connects an artery and vein together in the patient’s arm or thigh.

To maintain the proper functioning of fistula or graft, patients are advised to follow the guidelines listed below:

• Patients should inform the doctor, if they experience fever, chills, cold or blue fingers, or any signs of infection.
• Patients should maintain an appropriate hygienic lifestyle and proper hand washing. Patients should keep the access clean to prevent infection.
• Patients should avoid sleeping over the access arm. Never put pressure or weight on the access arm. Tight dressings should not be applied over the access. Do not wear wristwatch or tight jewelry on the access arm.
• Patients should not use the access arm to lift heavy weights.
• Patients should not do any weight- lifting exercises. Walking is the best exercise to improve blood circulation.
• Use the access arm in normal ways to improve blood circulation to the fingers and prevent the hand from becoming stiff.
• Patients should not have any blood tests drawn or blood pressure measurement done on the access arm.
• Cooperate with your nurse to ensure your access is checked before and after each dialysis treatment.
• Patient should avoid smoking. Smoking causes poor blood circulation.

In the beginning of the Dialysis treatment, it is important that the:

• Dialysis needle will be inserted in different places on the access with each treatment. Needle sticks done repeatedly in one place on the access weaken the wall of the fistula causing it to thin and bulge out. It can lead to having large holes in the graft.
• When the dialysis needle is removed from either fistula or graft, the dialysis nurse will apply slight pressure over the needle site for about 10 minutes to stop the bleeding.
• Do not apply tape around the arm, because it could stop the blood flow through the access and cause it to clot off, requiring special surgery to remove the clot.
• Keep a small supply of gauze in the car and at home. In case of bleeding, patient should stay calm and hold pressure over the site. If the bleeding does not stop, go to the nearest hospital emergency room for help.
• Inform dialysis nurse if any swelling, pain, drainage, redness, or heat is noticed at the access site. Check the functioning of the access daily at home as taught to you by the dialysis staff. If the access stops functioning, inform the dialysis staff/ doctor as soon as possible.
• Carry the dialysis record card (provided form dialysis unit) with you whenever you will go to another place or hospital.