〔Abstract〕 Objective To study the application value of vascular puncture technique of difficult arteriovenous fistula under the guidance of color doppler ultrasound. Methods A total of 130 patients who were admitted to the First Hospital of Longyan City from December 2018 to August 2021 and were divided into a control group and an observation group by random number table method, with 65 cases in each group. Patients in the observation group received arteriovenous fistula puncture guided by color doppler ultrasound, while patients in the control group received routine puncture, and the clinical application of different puncture methods was evaluated. Results The success rate of one puncture in the observation group was higher than that in the control group, and the puncture time was shorter than that in the control group, with statistical significances (P < 0.05). The incidence of complications in the observation group was lower than in the control group, the difference was statistically significant (P < 0.05). The total satisfaction of the observation group was higher than that of the control group, with statistical difference (P < 0.05). Conclusion Under the guidance of color Doppler ultrasound, the vascular puncture technology of difficult arteriovenous fistula is feasible. Compared with traditional puncture technology, it has a higher success rate of puncture, and can reduce the incidence of vascular complications in patients, and meet the requirements of clinical nursing intervention.