Haemodialysis Access

Creating an access to your bloodstream is an important step before starting dialysis. This should be done – in the best case – a few months before your first dialysis treatment. You may need to stay overnight in the hospital, but many patients have their access placed on an outpatient basis. This access will provide an efficient way for your blood to pass from your body to the dialysis machine and back with minimal discomfort. The two main types of access are a fistula and a graft. In every dialysis session two needles will be inserted in the fistula or graft.

Arteriovenous fistula

A surgeon makes a fistula by using your own blood vessels. An artery and a vein are connected – usually in your forearm. This connection allows a greater blood flow into the vein. With time, the vein grows larger and stronger and therefore can be used for repeated needle insertion. A fistula is the best long-term access for dialysis because it guarantees an adequate blood flow, lasts a long time, and has a low complication rate.

An arteriovenous fistula is a direct connection of an artery to a vein.


A graft connects an artery to a vein by using a synthetic tube. A graft doesn't need to develop over time the way a fistula does, so it can be used sooner after placement. However, a graft is more likely to have problems with infection and clotting.

A graft connects an artery to a vein by using a synthetic tube


If your kidney disease has progressed quickly, you may not have time to get a permanent access before you start haemodialysis treatment. You may need to use a catheter, a tube inserted into a vein near your neck/chest or leg near the groin, as a temporary access. Some people use a catheter for long-term access as well. Catheters that will be needed for more than about 3 weeks are placed under the skin to increase comfort and reduce complications.

This catheter is placed in a big vein, which passes into the heart.

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  1. Schönweiss G: Dialysefibel 3. abakiss Verlag