Background: Chronic kidney disease (CKD) patients undergoing hemodialysis are at risk of vascular access complications that may be associated with intradialytic emergencies. This study aimed to analyze the relationship between vascular access complications and intradialytic emergencies in CKD patients undergoing hemodialysis. Methods: This analytic observational study used a cross-sectional design and secondary data from medical records at the Hemodialysis Unit of Putri Hijau Level II Hospital, Medan. A total of 40 patients were selected using total sampling. Data were analyzed using univariate analysis and Fisher’s Exact test, with an alpha level of 0.05. The association was measured using the odds ratio (OR) and 95% confidence interval (CI). Results: Most respondents were aged 66–80 years (32.5%) and male (52.5%). An arteriovenous fistula was used by 77.5% of respondents. Vascular access complications occurred in 45% of patients, while 25% experienced intradialytic emergencies. Fisher’s Exact test showed a significant relationship between vascular access complications and intradialytic emergencies (*p* = 0.025). Patients with vascular access complications had higher odds of experiencing intradialytic emergencies (OR = 8.00; 95% CI: 1.42–44.92). Conclusion: Vascular access complications were significantly associated with intradialytic emergencies. Regular vascular access assessment, early complication detection, and appropriate monitoring are essential to support patient safety during hemodialysis.