Fistula and dialysis catheter care at home for the access that keeps dialysis possible.

Place two or three fingertips gently over the fistula, usually at the wrist or inner elbow, and you should feel a continuous buzzing or purring under the skin. That is the thrill, and it means blood is flowing through the access. Check it once a day at the same spot, ideally at the same time, so a change stands out. If the buzz is much weaker than yesterday or has gone, call the dialysis unit that day. Do not wait for the next session; a clotted fistula is sometimes rescued if the unit hears within hours.

A new fistula usually needs six to twelve weeks before it can be needled, and the surgeon will scan it to decide. Until then the arm is kept free of blood pressure cuffs, blood draws and drips, the patient does the hand-squeeze exercises only as the surgeon has said, and someone feels the thrill daily. Swelling in the first week is common; swelling that keeps growing, a hand that goes cold, or a wound that leaks are reported. In this period we place a nurse or an attendant briefed on the maturing-fistula rules, never a general caregiver.

Sit the patient down, put clean gauze on the site and press firmly without lifting to check. Keep pressing for the full time the unit has told you, which is usually ten to fifteen minutes, and then look. If it stops, put a fresh dressing on and leave the scab alone. If it has not stopped in the time the unit set, or if the bleeding is heavy or the patient feels faint, call the unit and, for heavy bleeding, 108. Bleeding that restarts more than once is worth mentioning at the next session; it can be the first sign of a narrowing above the fistula.

No. A permcath dressing is changed by a trained nurse using the unit’s protocol and a sterile technique, and only on the unit’s schedule or when the dressing is wet, loose or lifting. An attendant’s job with a catheter is to keep the dressing dry, prevent pulling or kinking, stop anyone using the line for anything else, and call a nurse or the unit when something is wrong. We book a nurse visit for the next day for a dressing that needs changing, and we never send an attendant to do it.

A fistula diverts a large amount of blood from the artery straight into the vein, and in some patients the hand beyond the fistula is left short. The hand becomes cold, pale, numb or painful, often worst during a session, and in severe cases the fingertips do not heal. It is more common in diabetic and elderly patients. It is reported to the dialysis unit and the vascular surgeon, who can measure the flow and sometimes correct it with a procedure. Our caregivers are briefed to notice it and report it rather than warm the hand and carry on.

Infection shows as fever or chills, sometimes only during or just after a session, with or without redness, tenderness or discharge at the exit site. A catheter patient with a fever goes to the unit or the emergency department the same day, because the infection can reach the bloodstream. A blocked line is usually found at the unit, when blood cannot be drawn or the machine alarms for poor flow, though a patient who notices a kink, a cracked hub or a line that has slipped outward should report it before the session.

It depends on what the access needs: a nurse visit for a dressing, a nurse on dialysis days, or an attendant briefed on access protection for daily care. A permcath that needs dressings twice a week and a mature fistula that only needs the arm guarded are different jobs. We quote after a free assessment that covers the access type, the dialysis schedule and who is at home. For how the levels are priced against each other, see our dialysis care cost guide.