AV Fistula and Dialysis Access

Haemodialysis needs a reliable way to take blood out and return it to the body. An arteriovenous (AV) fistula, a connection made between an artery and a vein in the arm, is the preferred long-term access because it lasts well and has a low risk of infection.

When dialysis is needed urgently, or while a fistula matures, a dialysis catheter is placed in a large vein under ultrasound guidance. Our nephrology team performs and looks after these access procedures.

• Advanced chronic kidney disease when dialysis is expected in the coming months
• Patients starting haemodialysis
• A failing or blocked existing access

• A fistula gives strong blood flow for effective dialysis
• Lower infection risk than long-term catheters
• Ultrasound-guided catheter insertion for safety

Before the procedure

Veins and arteries of the arm are assessed, sometimes with a Doppler ultrasound. Protect that arm from blood tests and drips.

During the procedure

Fistula creation is a minor operation done under local or regional anaesthesia. A catheter is inserted under local anaesthesia with ultrasound guidance.

After the procedure

A fistula usually needs several weeks to mature before it can be used. Hand exercises, such as squeezing a soft ball, help it develop.

Most patients go home the same day or the next day.

• Feel for the buzz (thrill) of the fistula every day and report if it stops
• Do not sleep on, carry heavy bags with, or allow blood pressure checks on the fistula arm
• Keep catheter dressings clean and dry