Step 1: Hand washing

The first step in using an access is for the staff person to wash his or her hands. This is important every single time. Hand washing and gloves are required by the Occupational Safety and Health Administration (OSHA). They protect both you and your care team member.

Make sure that whoever puts needles in your access washes his/her hands and puts on fresh gloves. Your unit will teach you how to wash your access arm. Even if you have taken a shower before coming to the unit, you should wash your arm before your treatment.

Step 2: Look for infection

The second step in using a vascular access is to look at the access very closely. At each dialysis, your nurse or technician will look for signs of infection or damage to the access. These include:

• Redness
• Warmth
• Tenderness
• Pus or open sores
• Swelling
• Ballooning of the access (aneurysm)

Putting needles through infected tissue can be dangerous for you. Harmful bacteria could be pushed into your bloodstream by the needles. This can cause sepsis, or blood poisoning. If you think your access may be infected, do not allow the staff to insert the needles.

Sometimes people with kidney failure don't get redness or swelling even when they have an infection. If you notice a fever or feel run-down, be sure to tell your care team.

Step 3: Listen for blood flow

If your access looks okay, the next step is to make sure that the blood flow through it is strong. The nurse or technician will place a stethoscope on top of your access to listen to the blood flow.

Step 4: Clean the access with germ-killer

The nurse or tech will clean off your access with a gauze pad and a germ-killing solution before the access is used for dialysis. The solution helps to keep germs that live on the skin from causing an infection.

Step 5: Insert the needles

Some people find that the needle sticks are not a big deal—a pinprick that lasts a second. Others are worried about them—sometimes a lot. Each unit does things a little differently. In some units, one or more medications may be available. And, depending on your insurance, you may or may not have to pay for them.

Before or after your access is checked and cleaned, a medication can be used to numb the needle sites. The medication will make you less likely to feel the needles—and can help you a lot if you are afraid of needles or worried about pain. Several medications are often used for numbing dialysis needles sites:

• Lidocaine – A tiny needle can be used to inject a small amount of this drug just under the surface of the skin over your access. Lidocaine stings for a moment, but people who use it say it's worth it. Some people believe that lidocaine may cause scarring over time that makes it harder to place the needles.
• Liquid lidocaine – This product is left on the skin for 5 to 10 minutes with a gauze pad over it instead of being injected. This saves two needle sticks per treatment.
• Chloroethane spray – This spray "freezes" the surface of the skin. If your access is deep, you may still feel some pain.
• EMLA® cream – EMLA cream must be put on in a dime-sized amount at least an hour or two before dialysis. Then it needs to be covered with a plastic dressing. Before dialysis, it is washed off. EMLA is costly, but it works very well. Insurance may not cover it—you may need to pay for it yourself.
• Topicaine® – This clear gel must be applied in a dime-sized amount 30 minutes to 1 hour before dialysis, and covered with a dressing. One study found that over-the-counter Topicaine worked faster than EMLA®, ELA-Max®, and tetracaine ointment, and it is often cheaper.
• Less-N-Pain™ – This product comes in single-use packets. It must be applied in a dime-sized amount over the needle sites at least 45 minutes before dialysis and covered with a dressing.