Dialysis access is the site created surgically to connect the bloodstream to the dialysis machine. There are three main types of dialysis access: an arteriovenous fistula (AV fistula), an arteriovenous graft, and a central venous catheter.

The AV fistula, often considered the gold standard, is created by connecting an artery directly to a vein, usually in the arm. This allows the vein to become stronger and larger so it can handle repeated needle insertions. A basilic vein transposition is a special variant of AV Fistula in which the entire basilic vein ( either in the forearm or in the arm) is brought superficially near the skin surface and connected to another artery. This is done if the patient doesn’t have suitable veins for an AV fistula or if there is a blocked AV fistula.

A graft uses a synthetic tube to connect the artery and vein, and is chosen when a patient’s veins are not suitable for a fistula. Central venous catheters are temporary access options, usually placed in the neck, chest, or groin, and carry a higher risk of infection.

If the access site bleeds more than usual after a dialysis session or starts bleeding on its own between sessions, it could be a sign of damage or an underlying narrowing or clotting issue. This needs urgent medical evaluation to prevent excessive blood loss. We can do angioplasty of a narrowed fistula and prevent its blockage if detected in time. 

Redness, warmth, swelling, and pus around the access site are classic signs of infection. Infections can also cause pain and tenderness. Since dialysis patients already have a higher risk of infections, any suspicion should lead to immediate consultation with a dialysis access specialist.

A persistent fever in a dialysis patient should never be ignored. It could indicate a bloodstream infection that may have started at the access site. Such infections can spread quickly and become life-threatening.

Swelling of the arm or hand near the fistula or graft, or a sudden cold sensation in the fingers, could mean that blood flow is restricted. This may occur due to narrowing or clotting in the access, which needs prompt treatment.

A healthy AV fistula or graft has a vibration known as a “thrill” and a sound called a “bruit” that can be felt or heard by touching or listening to the access. If these sensations become weaker or disappear, it may signal blockage or malfunction.

When the dialysis team starts finding it hard to insert the needle into the access site, it could mean that the vessel is narrowing or scar tissue is building up. This is a red flag that should be addressed early.

While mild discomfort is common during needle insertion, ongoing pain or pain at rest is not normal. Persistent or increasing pain needs investigation, as it could be linked to infection, clotting, or other complications.

Early Detection is Crucial

Spotting these signs early allows doctors to intervene before the access fails completely. This reduces the risk of emergency procedures and ensures that the patient continues to receive uninterrupted dialysis.

Infections Can Be Life-Threatening

An untreated infection can quickly progress to sepsis, which is a medical emergency. Patients with weakened immunity, like those on dialysis, are at higher risk, making timely action vital.

Access Failure Can Disrupt Treatment

If the access stops working, dialysis sessions will be delayed or interrupted. This can cause harmful build-up of waste products and fluids in the body, leading to symptoms such as breathlessness, swelling, and fatigue.

While weather and comfort can influence your timing, choosing the right doctor is the most important decision. A good vascular surgeon will evaluate your symptoms, investigate the root cause with the right tests, and guide you on whether to treat now or wait.

Avoid temporary solutions like creams or over-the-counter painkillers. These only mask symptoms and do not address the vein damage. A specialist will not only recommend the best time but also the best treatment, based on your unique condition.