Dialysis Fistula Problems: Don’t Wait Until It Blocks!
Changes in a dialysis fistula or graft deserve early attention. Dr Andrew Choong explains warning signs, assessment and treatment options before access failure disrupts haemodialysis.
A dialysis fistula or graft that becomes difficult to use, swollen, painful or slow to stop bleeding needs prompt review. These changes can signal a treatable access problem before the fistula blocks completely.
In this video, Dr Andrew Choong, vascular and endovascular surgeon in Singapore, explains why haemodialysis access problems should not be dismissed as minor technical difficulties.
Why is a working fistula so important?
An arteriovenous fistula connects an artery to a vein; a graft uses a tube to connect them. Both provide access to the bloodstream for haemodialysis. If the access suddenly clots, dialysis may be interrupted and a temporary catheter may be needed. Catheters have their own risks, including infection.
Our dialysis fistula and access guide explains the role of a reliable access in ongoing treatment.
Which changes should you report?
Tell your dialysis team if you notice, or are told about:
New or repeated difficulty inserting the dialysis needles.
Poor blood flow or unusually high machine pressures.
Bleeding that takes longer than usual to stop after needle removal.
Swelling of the access arm.
An access that becomes increasingly enlarged or painful.
These findings can reflect narrowing, a blockage, aneurysmal enlargement, infection or another flow problem. They do not establish a diagnosis on their own. The pattern of change and the examination help determine what needs investigating.
How are dialysis access problems assessed and treated?
Identifying the cause
Assessment includes reviewing how the access behaves during dialysis and examining the arm. Duplex ultrasound can assess blood flow and the vessels. A fistulogram uses contrast imaging to show the access circuit when appropriate.
Choosing a treatment
Depending on the problem, treatment may include balloon angioplasty to open a narrowing, a stent in selected circumstances, or surgical revision. If the access has clotted, a clot-removal procedure may be considered. The plan should fit the access anatomy and the patient’s overall dialysis needs; not every abnormality needs the same procedure.
Read about dialysis access salvage and fistula revision for the options and their limitations. Early assessment aims to preserve useful access where possible, but cannot guarantee that every fistula or graft can be saved.
When is urgent help needed?
Contact your dialysis team immediately if the usual vibration, or “thrill”, disappears or the access suddenly stops working. Redness, warmth, discharge, fever or chills also need prompt medical advice. Do not wait for the next routine dialysis session to report a sudden change.
For heavy or uncontrolled bleeding, collapse or severe breathlessness, call 995 in Singapore. Emergency care takes priority over a clinic booking.
Arrange an early access review
For ongoing access difficulties, coordinate with your dialysis team and contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore. Bring recent dialysis records and previous access procedure reports if available. You can also watch this explanation in the video library.