Dialysis Access Problems: Warning Signs and What to Do

Act now: which symptoms need which response

Emergency — call 911:

• Heavy or uncontrolled bleeding from the access. Apply firm, direct pressure while help is on the way. There is no "wait and see" period for heavy bleeding.

Call your dialysis or access team immediately:

• The thrill (vibration) is absent or feels very different
• You suspect the access has clotted
• Dialysis couldn't be completed because of the access
• Severe pain, coldness, or numbness in the access hand
• Signs of infection: spreading redness, warmth, fever, or drainage

Signs to report promptly (not emergencies)

• A gradual change in how the thrill feels
• New or increasing swelling in the access arm
• Bleeding after needle removal that takes longer than usual to stop
• The access site looking different than normal

Many access problems give warning signs like these — but not all do. Some develop suddenly, which is why knowing your access's normal feel, and acting fast when it changes, matters more than any checklist.

What evaluation involves

When a problem is suspected, the specialist examines the access and typically performs a fistulogram — an imaging study that uses contrast dye and X-ray to show how blood is flowing through the access and where a problem is. What happens next — treatment such as angioplasty or declotting, sedation, and where care happens — depends on what's found and on your condition. Many problems can be treated the same visit; some need a different setting.