How Your Access Works

A haemodialysis access, or vascular access, is a way to reach the blood for haemodialysis. The access allows blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter, called a dialyzer. An access is placed by a minor surgery. As a haemodialysis patient, your access is one of the following:

• Fistula: an access made by joining an artery and vein in your arm.
• Graft: an access made by using a piece of soft tube to join an artery and vein in your arm.
• Catheter: a soft tube that is placed in a large vein, usually in your neck.
• If your access is a fistula or graft, your nurse or technician will place two needles into the access at the beginning of each treatment. These needles are connected to soft tubes that go to the dialysis machine. Your blood goes to the machine through one of the tubes, gets cleaned in the dialyzer, and returns to you through the other tube. If your access is a catheter, it can be connected directly to the dialysis tubes without the use of needles.

A fistula should be considered the first choice for your access because it generally lasts longer and has fewer problems such as infections and clotting. However, some patients may not be able to receive a fistula because their blood vessels are not strong enough. A graft is considered the second choice for an access. Catheters are generally used as a temporary access, but sometimes they are permanent. Sometimes, it may be possible to switch to a fistula from another type of access. If you do not have a fistula, ask your dialysis care team if a switch would be possible for you.