What are the types of dialysis access?

For haemodialysis: an AV fistula (an artery joined to a vein, the preferred long-term access, lowest risk but takes weeks to months to mature), an AV graft (a synthetic tube, usable sooner but higher risk), and a tunnelled catheter/line (immediate but highest infection and clotting risk). PD uses the abdominal catheter and exit site.

How do I protect my fistula arm?

No blood-pressure cuffs, blood tests, needles or drips on that arm, and no tight clothing, watches or jewellery, because squeezing can damage the access or clot it. Tell every healthcare worker which arm has your access, and avoid sleeping on it or carrying heavy bags over it.

What is the “thrill” and why check it?

A working fistula or graft has a constant buzz or vibration you can feel, called the thrill, plus a whooshing sound. Check it every day so you know your normal and would notice a change; it confirms blood is flowing through the access. A lost thrill can mean clotting.

What are the signs my access is clotted or infected?

Loss of the thrill, or the access feeling different or not working, can mean clotting: contact your unit urgently the same day, as it may be saved if treated fast. Redness, heat, swelling, pain or discharge, especially with fever, means infection and needs urgent review.

Dialysis Access: Fistula & Catheter Care

Q: What do I do if my access bleeds?

Apply firm, continuous pressure to the spot. A fistula is a high-flow vessel, so if bleeding does not stop, spurts, or is heavy, it is an emergency: call 995 and keep pressing. Do not release repeatedly to check. Any needle-site bleeding after a session should settle with steady pressure.

Written & reviewed by the BestDoctors.sg editorial team · Last updated 28 Aug 2026 · General information, not medical advice

Your dialysis access is your lifeline, the point through which dialysis is done, and looking after it well is one of the most important parts of life on dialysis. Good access care keeps dialysis running smoothly and, crucially, guards against the bleeding, clotting and infection that can put your access, and you, at risk. This guide explains the types of access and how to protect them, with the warning signs that need urgent action.

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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.

This is general information and does not replace your renal team’s training. Protect your fistula arm: no blood-pressure cuffs, blood tests, drips or tight clothing on it. For bleeding that will not stop with firm pressure, call 995. If you lose the buzz (thrill) over your fistula, contact your unit urgently the same day. A hot, red, swollen or leaking access needs urgent review.

What access is

Access is the way dialysis reaches your bloodstream or, for peritoneal dialysis, your abdomen. For haemodialysis, blood needs to be taken out and returned, so you need access to a blood vessel. For peritoneal dialysis, the access is the PD catheter and its exit site, covered in our PD guide. This guide focuses mainly on haemodialysis access, of which there are three main kinds, each with its own advantages and care.

The AV fistula

The preferred long-term access for haemodialysis is an arteriovenous (AV) fistula. A surgeon joins an artery to a vein, usually in the arm, and over weeks to months the vein enlarges and strengthens, or “matures”, until it is strong enough to take the two dialysis needles. A fistula is favoured because it generally lasts longest and has the lowest risk of infection and clotting. Because it takes time to mature, it is usually created well before you need to start dialysis.

Grafts and lines

When someone’s own veins are too small or unsuitable for a fistula, an AV graft may be used instead, joining an artery and vein with a soft synthetic tube. A graft can often be used sooner than a fistula matures, but carries a higher risk of clotting and infection. A tunnelled central venous catheter, or line, placed in a large vein in the neck or chest, is used when a fistula is not ready or not possible, or dialysis is needed urgently. A line can be used immediately but has the highest infection and clotting risk, so it is not the first choice for the long term.

Protect your fistula arm

This is one of the golden rules of dialysis. On the arm with a fistula or graft, there should be no blood-pressure cuffs, no blood tests or other needles, and no drips, and no tight clothing, watches or jewellery, because anything that squeezes the arm can damage the access or cause it to clot. Tell every healthcare worker, including at other clinics and hospitals, which arm has your access, so it is not used by mistake. Avoid sleeping on it or carrying heavy bags over it.

Feel the thrill and keep it clean

A working fistula or graft has a constant buzz or vibration you can feel with your fingers, called the thrill, and a whooshing sound. Check your thrill every day, so you know your normal and would notice a change, and confirm blood is flowing through the access. Keep the access clean: wash the arm and skin as instructed, and keep your nails and skin clean before dialysis. For a catheter or line, keep the dressing intact, dry and covered exactly as your unit advises, since a break in the dressing is a direct route for infection.

Red flags: bleeding, clotting and infection

Three warning signs need action. Bleeding from a fistula or graft, especially after needles are removed, needs firm, continuous pressure; a fistula is a high-flow vessel, so if bleeding does not stop, spurts, or is heavy, it is an emergency, call 995 and keep pressing. Loss of the thrill, or the access feeling different or stopping working, can mean it has clotted; contact your unit urgently the same day, as a clotted access may be saved if treated quickly. Infection, redness, heat, swelling, pain or discharge at an access or exit site, especially with fever, needs urgent review.

Getting help in Singapore

Put simply, protect your access arm, check your thrill daily, keep everything clean, and act fast on the three red flags. For bleeding that will not stop with firm pressure, call 995. For a lost thrill, or a hot, red, painful or leaking access, contact your dialysis unit urgently. In Singapore, your hospital renal team and your dialysis centre are your first contacts for access problems, and 995 is the emergency number. Looking after your access well is one of the best things you can do for your dialysis.

Sources

National Kidney Foundation – Hemodialysis access: kidney.org
NHS – Dialysis, how it is done: nhs.uk
Kidney Care UK – Haemodialysis (patient information): kidneycareuk.org
National Kidney Foundation – Hemodialysis: kidney.org

General information only. This guide supports, but does not replace, the advice of your kidney (renal) team, who set your dialysis, diet, fluid limits and medicines. Never miss or shorten a dialysis session without contacting your unit, and protect your fistula arm (no blood-pressure cuffs, blood tests or tight clothing on it). Contact your dialysis unit at once if your drained peritoneal-dialysis fluid looks cloudy or you have tummy pain and fever (a possible peritonitis), or for a hot, red, painful or leaking access site. Call 995 for bleeding from your access that will not stop with firm pressure, or for severe breathlessness (a possible dangerous fluid overload). If you are struggling emotionally, you are not alone: the Samaritans of Singapore (SOS) are on 1767 and mindline.sg on 1771.

Dialysis Access: Fistula & Catheter Care (Singapore)