bjective  To explore the effect of arteriovenous fistula (AVF) management based on cognitive load theory in maintenance hemodialysis (MHD) patients with AVF established for the first time.  Method  A total of 42 MHD patients who had AVF for the first time from June 2019 to May 2020 were selected as the observation group to implement AVF management based on cognitive load theory; a total of 44 MHD cases with conventional AVF management from June 2018 to may 2019 were taken as the control group.  Result  After the intervention, the AVF related knowledge score was 95 (90.00, 100.00) in the observation group and was 80 (75.00, 85.00) in the control group (Z=-6.709, P<0.001). There was significant difference in compliance behavior between the two groups (χ2=29.951, P<0.001); the complete compliance rate in the observation group was 59.5% and was 6.8% in the control group (χ2=27.185, P<0.001). The success rate of first internal fistula puncture within one year after the operation was 99.7% in the observation group and was 99.4% in the control group (χ2=6.496, P=0.011). The rates of thrombosis and insufficient blood flow within one year after the operation were 7.1% and 2.4% respectively in the observation group and were 22.7% and 13.6% respectively in the control group (χ2=4.067 and 5.726, P= 0.044 and 0.017).  Conclusion  The AVF management model based on cognitive load theory is helpful to improve the quality of health education and the success rate of first internal fistula puncture in MHD patients. Therefore, this management model can reduce the AVF complications and is worthy of promotion in clinical practice.