Arteriovenous endovascular fistula first use puncture point is generally selected from the anastomosis about 5cm, the direction of venous needle puncture toward the proximal end, the direction of the arterial needle puncture pointing to the anastomosis, to avoid two needles at the same time in the arterial puncture. Arteriovenous endovascular fistula puncture requires arteriovenous endovascular fistula and venous two needle distance is generally >5cm appropriate, arteriovenous endovascular fistula distance from the fistula should be at least 3~5cm above, do not puncture on the fistula, so as not to affect the service life of the endovascular fistula. In the puncture process, the first thing to do is to puncture the vein, determine the puncture point after tying a tourniquet, and then disinfect and spread the towel; as far as possible, the direction of the puncture needle is to the proximal end of the puncture, and the angle is generally 20~30 °, and after confirming the success of the puncture, the needle will be fixed. For the arterial end of the puncture, the direction of endovascular fistula puncture as far as possible to the direction of the fistula, according to the conditions of the blood vessels can be selected button puncture or step puncture, to determine the puncture point, the other process and the puncture of the venous end of the same. At the end of the puncture, we should explain the precautions to the patient and fix it to prevent the needle from slipping off during the dialysis process, resulting in the risk of bleeding.