Version July 2025
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What is hemodialysis? —
This is a treatment for kidney failure. Normally, the kidneys filter blood and remove waste and excess salt and water. Kidney failure, also called "end-stage kidney disease," is when the kidneys can no longer filter blood properly.
With hemodialysis, a machine takes over the job of the kidneys. It pumps blood out of the body, filters it, and returns it to the body (figure 1). People have hemodialysis 3 times a week (every other day) or more often.
What is arteriovenous vascular access? —
"Arteriovenous" ("AV") means connecting an artery to a vein. "Vascular" means related to the blood vessels. "Access" means a way to get in.
An AV vascular access is a way for blood to leave and return to the body during hemodialysis. Your doctor will do surgery to create an access under your skin, usually in the lower part of your arm. How soon it can be used after surgery depends on the type of access.
There are different types of AV access:
●AV fistula – Most people get this type (figure 2). To make it, a doctor does surgery to connect an artery directly to a vein. Sometimes, they can do this by putting a needle through the skin instead of making a cut ("incision"). An AV fistula needs to heal for 2 to 4 months or more before it can be used for dialysis.
●AV graft – To make this type, a doctor uses a plastic tube to connect an artery to a vein (figure 3). An AV graft usually needs to heal for 2 weeks before it can be used for dialysis. Some can be used after a couple of days.
How do I prepare for surgery? —
The doctor or nurse will tell you if you need to do anything special to prepare.
Before the procedure, your doctor will do an exam. They might send you to get an ultrasound or other imaging tests to see which blood vessels have the best size and blood flow. (Imaging tests create pictures of the inside of the body.)
Your doctor will also ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:
●Any other kind of vascular access you might have had – This includes if you had any "central venous catheters" for hemodialysis or for any other reason.
●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.
●Any allergies you have
●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.
You will also get information about:
●Eating and drinking before the procedure – You might need to "fast" before surgery. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.
●Lowering the risk of infection – You might need to wash the area with a special soap.
●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.
●Your dialysis schedule – If you are already getting dialysis, your AV access procedure will probably be scheduled in between sessions. If you have not yet started dialysis, you will get information about when to schedule it.
Ask the doctor or nurse if you have questions or if there is anything you do not understand.
What happens during surgery? —
When it is time for the procedure:
●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.
●You will get anesthesia medicines. This is to make sure you do not feel pain during the procedure. Types of anesthesia include:
•Local – This numbs a small part of your body so you don't feel pain.
•Regional – This blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. You might be awake. Or you might get "sedative" medicines to make you relax and feel sleepy.
•General – This makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.
●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.
●The doctor will make a small incision over your blood vessels. Or they might use a needle to access your blood vessels.
●They will join your artery and vein together to create the access. They might connect the blood vessels directly or use a small plastic tube to connect them.
●The doctor will close your incisions and cover them, or the place where the needle went through your skin, with clean bandages.
●The AV access can be used for dialysis within days to months. This depends on the type of access.
What happens after surgery? —
You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people can go home the same day.
As you recover:
●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.
●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.
●You will get medicine to help with pain, if needed. You might need other medicines, too.
●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.
What are the risks of vascular access? —
Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:
●Bleeding
●Swelling in the hand or arm
●The access not having good blood flow or not fully healing
●Infection
●Decreased blood flow to the hand, which can cause problems like pain, cold or pale skin, tingling, or trouble moving
What follow-up care do I need? —
Your doctor or nurse will tell you when you need to make a follow-up appointment. Make sure you know when and where to go.
When should I call the doctor? —
Call for advice if:
●You have symptoms of infection – These include a fever of 100.4°F (38°C) or higher, chills, and color changes, drainage, warmth, or pain over the access.
●Your arm or hand is tingling, feels numb, or is pale or cold.
●You have sudden problems with your hand, like pain or trouble moving normally.
●You have bleeding from your access that does not stop with gentle pressure.
What else should I know? —
Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.
Patient education: Hemodialysis (The Basics)
Patient education: Hemodialysis catheter placement (The Basics)
Patient education: Preparing for hemodialysis (The Basics)
Patient education: Peritoneal dialysis (The Basics)
Patient education: Dialysis and diet (The Basics)
Patient education: Chronic kidney disease (The Basics)
Patient education: Hemodialysis (Beyond the Basics)
Patient education: Peritoneal dialysis (Beyond the Basics)
Patient education: Chronic kidney disease (Beyond the Basics)
