This page is written for nephrologists, dialysis nurses and other clinicians. Patients and families may prefer Common Dialysis Access Problems.
Patients with stage 4–5 chronic kidney disease who may need dialysis within about a year should have their vascular access planned early. Patients who already have an access should be referred to a vascular surgeon promptly if they develop rising venous pressure, falling access flow or dialysis adequacy, prolonged bleeding after needle removal, difficult cannulation, a weaker or absent thrill, limb swelling or pain, or signs of infection.
1. No access yet: when to start planning
- Pick the timeFor patients with stage 4–5 chronic kidney disease who may need dialysis within about a year, we suggest evaluating the vascular access before dialysis is needed.
- What the evaluation includesHistory and physical examination, duplex ultrasound of both arms, and a discussion of the access type (autogenous fistula or graft) and site that suit the patient’s vessels and daily life.
- Protect the armWhile planning, ask the patient to protect the arm intended for the access: avoid blood draws, IV lines and peripherally inserted central catheters (PICC) in that arm.
2. Existing access: findings that call for referral
3. Emergencies
Act immediately
- Bleeding from the access: apply direct pressure at the site right away and go to the emergency department.
- Sudden complete loss of the thrill: this may be thrombosis. Please contact us promptly; the sooner it is treated, the better the chance of keeping the existing access.
4. Information that helps with a referral
- Access type and location (autogenous fistula or graft, left or right arm, site) and the date it was created
- Recent dialysis monitoring: venous pressure, access flow, dialysis adequacy and post-needle bleeding time
- Previous tests and procedures (ultrasound, fistulography, angioplasty, surgery)
- Current anticoagulant and antiplatelet medicines, and important comorbidities (for example heart disease or diabetes)
- The most recent imaging report, if available
5. Evaluation and treatment we provide
Dr. Ta-Wei Su is a vascular surgeon. Care for hemodialysis access includes the items below; the actual treatment depends on each patient’s vessels and condition.
6. How to reach us
Clinicians, patients and families are all welcome to contact us directly. Please bring any access-related reports and dialysis records.
Patient education summaries
These topic pages gather our articles into questions and answers, and can be shared with patients and families when you refer them.
Frequently asked questions (FAQ)
When should vascular access planning start?
We suggest evaluating the access when a patient has stage 4–5 chronic kidney disease and may need dialysis within about a year, rather than waiting until dialysis is unavoidable. The exact timing should be discussed with the patient’s nephrologist.
If a dialysis nurse notices rising venous pressure, should we wait until dialysis becomes impossible?
No. Rising venous pressure, falling flow and longer bleeding times are often early signs of stenosis. Earlier evaluation gives a better chance of preserving access function with a smaller procedure.
Can patients or families contact us directly?
Yes. Please call the numbers above or use our official LINE, and bring any access-related reports and dialysis records.
Reference
Lok CE, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1–S164.
This page is professional reference information and does not replace clinical judgment. Evaluation and treatment depend on the individual patient. It makes no comparison with other facilities and is not a guarantee of results.
