Daily Care of Your Dialysis Access: 10 Common Questions

Look, feel and listen. Look for an access that is getting bigger or red, and for swelling in the arm or hand. Feel with your fingertips for a steady vibration. Listen for the soft whooshing sound, like wind. At each session, note the arterial flow rate and venous pressure so the care team can review them.

Hold a ball in your palm, squeeze for five seconds, then relax. You can build up the repetitions over the day, and some people reach 500 or more; if your hand becomes uncomfortable, rest rather than finishing the count. A hand grip device works too. The exercise tightens the forearm muscles and increases blood flow, which helps a fistula mature.

Yes. Use a heating pad, or a hot-water bottle filled with warm water at about 40 to 45 °C, over the vessel that will be needled, for 15 to 20 minutes at a time. A warm towel also works. Check first that the skin is unbroken and not irritated. People with diabetes or reduced sensation need to be especially careful about burns. If the wound has not healed or the access is red and inflamed, ask your doctor first.

Some studies suggest far-infrared therapy may improve circulation around the access and help keep it open. It is supportive care, not treatment, and does not replace clinic visits or ultrasound follow-up. In the studies, it was mostly applied for about 40 minutes during dialysis, three times a week. After surgery, ask your doctor before using it until the wound has healed, and if you have diabetic neuropathy, take care to avoid burns.

Rest your fingertips lightly on the access. Normally you feel a steady vibration, a little like a buzz. If it is weaker than usual, different from before, or gone, contact the dialysis unit or come to clinic soon. You can also listen with a stethoscope: normally it is a soft whoosh like wind, and if it turns high-pitched and sharp or disappears, please come in.

Press just firmly enough to stop the bleeding, and do not use a tourniquet to squeeze the needle sites too tightly, since pressing too hard may make the access more likely to clot. How long it takes differs from person to person, so follow what your dialysis nurse has taught you. If bleeding takes clearly longer to stop than usual, the outflow may have narrowed; tell the nurse so that a check can be arranged.

It is best to avoid blood pressure measurements, blood draws and heavy lifting on the access arm, to reduce pressure on the vessel. When blood has to be drawn or an IV placed, tell the staff that this arm has a dialysis access.

When systolic pressure falls too low after dialysis, below 90 mmHg, the chance of the access clotting goes up. If you often feel dizzy or your pressure runs low after dialysis, tell the dialysis unit and your nephrologist so that it can be adjusted together.

Diet depends on each person’s blood results and urine output, and no single way of eating suits everyone. This site has a downloadable “Dietary and Lifestyle Guidance for Dialysis” provided by Ms. Shu-Tzu Chen, convener of the kidney group of the Taiwan Dietitians Association. For any change in diet, please talk with a dietitian and your nephrologist.

Yes, but it needs to be arranged ahead of time. Before leaving, contact your dialysis unit in Taiwan and the dialysis center at your destination to exchange medical records and book a chair, and confirm the settings, such as the dialyzer, needle size, ultrafiltration rate and heparin dose. Please also talk with your doctor before you go. This site does not recommend any travel service.