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Hemodialysis filters the patient’s blood to rapidly remove fluid and solutes. Home hemodialysis is possible for select patients. Specialized vascular devices enable rapid infusion and removal of blood. These devices must be able to support over 350 mL/min of blood flow, with some patients achieving rates of 600‐1200 mL/min [3].

A dialysis patient’s access site should not be used except in critical emergencies (e.g., cardiac arrest resuscitation). Patients are advised to avoid use of blood pressure cuffs, tourniquets, and venipuncture on the extremity that has their access, and they will typically convey this concern to EMS personnel [4]. There are several dialysis access options:

 AV fistula – a surgically created connection between an artery and a vein, usually from the brachial or radial artery to the cephalic vein. It takes longer than 4 weeks, and often more than 8 weeks, to “mature” and be ready to use. A patient may have a fistula created and be in the process of maturation while using a different access device for dialysis [5].

 AV graft – similar to a fistula, the artery and the vein are connected by way of a synthetic device. It is more prone to complications than a fistula [5].

 Tunneled catheter – a large IV catheter that accesses a central vein, usually the internal jugular [6]. Prior to entering the vein, the catheter is run through the skin and soft tissue from a different site (i.e., tunneled). Doing so reduces risks of infection and need for frequent dressing changes [7]. The catheters are often held in place by balloons and other securing devices. This method has the advantage in that it is immediately available for use once inserted. Compared to other long‐term methods of venous access, the catheter has the highest rates of complication and mortality [4,7].

 Nontunneled catheter – a large‐bore IV in a central vein with two ports. It is typically used as a temporary bridge to a different device [8].