Vascular access is the lifeline of hemodialysis patients. It is very important to establish vascular access in time and maintain the vascular access in good-function. The increase of the elderly and diabetic nephropathy has increased the difficulty of establishing internal fistula. The expansion of various specialized techniques and treatment methods has affected the establishment of vascular access, and the dialysis time extension has exhausted blood vessels. All of the above has made vascular access physicians face enormous challenges. This paper paid attention to some clinical issues to protect blood vessel resources, analyzed for correct selection of vascular access, further introduced maintenance of the internal fistula and real-time intervention techniques, shared the application and management experience of the tunnel catheters with polyester sleeves, and emphasized multidisciplinary cooperation to develop intervention nephrology.