Before you start haemodialysis you need a vascular access. This is the site on your body where blood is removed and returned during dialysis. To have a sufficient amount of blood cleansed during haemodialysis the vascular access should allow high volumes of blood flow. The most common permanent access for a patient undergoing chronic haemodialysis is a native arterial-venous fistula (AVF) A V fistula is a route made surgically by joining an artery to a vein. Construction of A V fistula is a minor surgery which is done by a Vascular Surgeon. Once it is constructed, it cannot be used immediately for dialysis. It needs 4 – 6 weeks to mature (blood vessels need to become strong enough to allow a rapid flow of blood through it). Exercising your arm before and after surgery may encourage a fistula’s development and maturation. Once mature, a fistula is easier for the dialysis staff to puncture in order to get a good blood flow needed for dialysis.