March 9, 1960, was a milestone marker in end stage renal disease history - the date when a patient received the very first arteriovenous Scribner shunt. This began the era of maintenance or chronic hemodialysis. With long-term dialysis a reality, various new types of vascular access were developed. As the American Nephrology Nurses' Association celebrates its 40th anniversary, this article looks back to see just how far vascular access has come and what might be in store for the future.