Vascular access is crucial for patients under hemodialysis. Adequate arteriovenous (AV) fistula puncture is a challenging technique, which affected the quality of hemodialysis and the durability of AV fistula. The article is aimed at how to access and puncture AV fistula, to provide the clinical instruction and reference for clinical nurses to access and puncture AV-fistula. Having correct conception and comprehensive learning, we hope it will decrease the failure rate of AV-fistula puncture and provide better service of hemodialysis.