Hemodialysis is currently one of the main treatments for chronic renal failure, and the establishment of good vascular access is the primary condition for the successful implementation of long-term maintenance hemodialysis, which has an important impact on the dialysis outcome and long-term survival of patients. Arteriovenous endovascular fistulas have been used in clinical practice since 1966, with the advantages of long duration of use, low infection rate, and ease of movement. Endovascular fistulas are generally made from left to right, from far to near, top to bottom, and own vessels before graft vessels. Since endovascular fistulas are so important to dialysis patients (they are the patient’s lifeline, so to speak), they should be cared for and cherished. For patients on maintenance dialysis, it is important to protect the integrity and cleanliness of the skin of the limb on the side of the fistula and to protect the blood vessels of the limb on the side of the fistula and not to perform venipuncture on the limb. 2, after the fistula should be properly elevated limb about 30 degrees, to keep its blood flow smooth to avoid pressure, pay attention to keep warm. 3. Touch the surgical site for vascular tremor and listen for vascular murmurs. Do not over-wrap the fistula, and pay attention to the presence of hematoma and ecchymosis at the fistula, and to the presence of local blood oozing. 4, the second day after surgery for functional exercise: can be repeatedly alternating fist movements or repeatedly squeeze the grip ball or intermittent hot compresses above the internal fistula veins, 3-4 times a day, to promote vasodilation. But pay attention to the functional exercise should be light at the beginning of the action, the strength of the fist should be slowly increased from small to large. 5, internal fistula side of the limb is prohibited to measure blood pressure, infusion, blood draw, not too tight sleeves, avoid lifting heavy objects. 6. The internal fistula is best used 4-6 weeks after surgery. The ideal internal fistula is characterized by fully dilated and hypertrophied veins. (At the same time, a pair of elastic bandages should be prepared to stop bleeding after needle extraction).7 Excessive limb movement should be avoided during dialysis to avoid thrombosis caused by damage to the intima of the puncture needle. 8, after the needle is removed at the end of dialysis, compression to stop bleeding is also an important part of protecting the internal fistula, patients should master the skills of compression themselves. The eye of the needle is usually compressed with a 1 cm square of gauze to stop bleeding, or you can use a band-aid on it and then compress it with a gauze block. The pressure should be appropriate, so that both hemostasis and vascular tremor can be felt. Generally, the gauze is relaxed for half an hour, removed for 2 hours, and scrubbing of the puncture site is prohibited for 24 hours. At the end of the graft vascular dialysis, the puncture needle entry should be compressed for a longer period of time than in the case of direct arteriovenous fistulas. If the compression is inappropriate: too heavy or too light or too long, it can cause subcutaneous hematoma, varying degrees of damage to the vessels and cause internal fistula occlusion. 9, before dialysis should keep the arm clean, often wet and hot compresses, after the puncture can be applied some Xanadu ointment. In winter, pay attention to limb warmth to avoid cold spasms of the blood vessels. 10, dialysis patients should often self-test fistulas for tremors or vascular murmurs to avoid fistula infection or occlusion. Once you find that the fistula tremor or murmur disappears or is painful, go to the hospital immediately. 11.As medical staff, we will strictly enforce aseptic operation and master the puncture technique to prevent the occurrence of medical source damage.