What you may notice
A dialysis fistula or graft is the access used to move blood to and from the dialysis machine. A weaker or absent usual vibration, difficult needling, reduced dialysis flow, arm swelling or bleeding that takes longer to stop may indicate an access problem.
A surgically joined artery and vein
What could cause it?
A narrowed outflow vein, a clot, infection or a damaged or enlarged access segment may be responsible. Cold or painful fingers can indicate inadequate hand circulation. The dialysis team examines the access and may arrange ultrasound or a fistulogram. A machine alarm alone does not establish which problem is present.
When to contact a doctor
Contact the dialysis team urgently the same day if the usual vibration disappears, dialysis cannot proceed, the arm becomes swollen, or there is redness, fever or hand pain. For heavy access bleeding, apply firm pressure directly to the bleeding point and call 108; do not wait for the next dialysis session. Ulcerated or thinning skin over an access also needs urgent review.
How interventional radiology may help
IR can assess the access and may open a suitable narrowing with a balloon or clear a clot, sometimes using a stent in selected circumstances. Surgical repair or a different dialysis access may be needed. Infection and threatened hand circulation require their own treatment plans. Earlier assessment can help preserve options, but access salvage cannot be promised.
Further reading: detailed assessment and treatment options
Patient information sources
References are in English.
Educational information, not a diagnosis. The causes listed are examples, not a complete list. Tests and treatment depend on your individual assessment.