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Thrive On

Choosing Your Best
Dialysis Access

When facing dialysis, there are different types of dialysis access to consider. Peritoneal dialysis (PD) uses only one type of access—a peritoneal dialysis catheter. Hemodialysis (HD) uses an arteriovenous (AV) fistula or graft—or, if medically necessary, a hemodialysis catheter. Ideally, you want the access type that gives you the best quality of dialysis treatment and the lowest risk of infection. Talk to your doctor to determine which type of access is right for you.
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Types of dialysis access

For peritoneal dialysis access

Benefits of Home Dialysis

Peritoneal dialysis catheter

A PD catheter is a flexible tube placed in your abdomen—with a small piece of tubing left outside of the body.

Healing time after surgery: A few days to 2 weeks, depending on the urgency to start treatment. A PD catheter can also be placed in advance for a quick start when ready.

Key considerations

  • A PD catheter is the only access type for peritoneal dialysis.
  • It requires no needles during dialysis.
  • You must have a clean treatment environment to avoid infection.

For hemodialysis access

Arteriovenous fistula

Arteriovenous (AV) fistula

An AV fistula is an access site formed by the joining of a vein and an artery in your arm.

Healing time after surgery: 6-8 weeks to mature

Key considerations

  • An AV fistula is the best choice for hemodialysis access if you're eligible.
  • It's the most natural access site since it's formed from your own blood vessels.
  • A fistula has the lowest chance of infection and clotting.


A graft is an access site formed by a piece of soft tubing that connects a vein and artery in your arm.

Healing time after surgery: 2-3 weeks

Key considerations

  • A graft is a great alternative if your veins are too small or weak for a fistula.
  • It offers better blood flow and has a lower risk of infection than an HD catheter.
  • A graft may be replaceable with a fistula if veins get stronger or bigger after being on dialysis.
Hermodialysis catheter

Hemodialysis catheter

An HD catheter is a tube placed in your neck, chest or groin.

Healing time after surgery: Ready for immediate use after placement—not recommended unless medically necessary

Key considerations

  • A hemodialysis catheter is often used temporarily until a permanent graft or fistula is ready for use.
  • It has a higher risk of infection and clotting due to the catheter tip's location being near the heart.
  • A hemodialysis catheter must be kept dry, which can limit bathing options.

tips for avoiding a dialysis access infection

Caring for your access is key

Your access is your lifeline, so you'll need to keep it clean—avoiding infection is a top priority. With any type of dialysis access, a healthy access site can help ensure that your treatment is effective and you experience minimal pain and discomfort so you can feel your best.

The basics of caring for your access site:

  • Practice good hygiene—clean or sanitize your hands and wear a mask for at-home treatment.
  • Check for infection—inspect your access site for changes in appearance.
  • Protect your site—avoid clothing that rubs or sleeping positions that irritate your access.
  • Talk to your nurse—if there's an issue or a question, act fast to avoid complications.
Learn more about peritoneal dialysis catheter care
Explore treatment options

There are several treatment options when kidneys fail during ESRD. Discuss all the choices with your doctor to determine what's right for you.

Learn more

Switching from in-center dialysis to home dialysis

Making sure you have the best access type for you

If you're going to start hemodialysis, an AV fistula is the best access type if you have adequate vein strength and size. A graft is also a great choice if you're unable to get a fistula.

Vein mapping is an important first step.

Getting a painless, noninvasive vein-mapping test helps your doctor assess the condition of your veins and determine which type of access will work best for you. Ask your doctor about the test if you haven't had one already.

Switching access types may be an option.

If you currently have a hemodialysis catheter and you're medically able to have another type of access, talk to your doctor right away about switching to a preferable option.

If you currently have a graft, your vein strength and size may increase once you're on dialysis—making a fistula a possibility.

Ask your doctor about vein mapping and learn about your access choices.

Planning your access surgery
Once you and your doctor have decided on an access type, you’ll want to schedule your surgery. Azura Vascular Care, an affiliate of Fresenius Kidney Care, offers minimally invasive, outpatient dialysis access surgery.
Find a location near you