Bedside Ultrasonography for Arteriovenous Fistula Cannulation

Abstract

Difficulty in accessing a new arteriovenous fistula (AVF) is a common technical issue in hemodialysis patients, which often leads to interventional radiology and/or vascular surgery referral. As a consequence, the patient who needs dialysis may require a temporary dialysis catheter with its known potential complications. We present a case where bedside ultrasonography facilitated successful cannulation of a difficult AVF. Ultrasonography (US) training in this procedure may allow early cannulation of new AVFs when the venous diameter is large enough (>0.6 cm) but the fistula is too deep (>0.6 cm). Real-time, US-guided AVF cannulation may also decrease the number of failed venous punctures per hemodialysis (HD) session minimizing vessel wall damage and subsequent potential hematoma and aneurysm formation.

Clinical practice guidelines for the provision of renal service in Hong Kong: Renal Nursing Practice

“…The vessels‐diagnostic mapping for ensuring the creation site of AV access may improve AVF patency. It guide and assess the feasibility of AV access placement, and determine the optimal location of AV access placement …”

“…It guide and assess the feasibility of AV access placement, and determine the optimal location of AV access placement. 21,[24][25][26] Rationale of Statement 6 AV fistula, AV graft and tunnelled catheters are the choices of vascular access for chronic HD, the latter is the least optimal choice. Early referral, optimal AV access choice and vein preserving will help in establishing a functioning AV access for consistent haemodialysis.…”

Self‐cannulation of the vascular access in home hemodialysis: Overcoming patient‐level barriers

“…The use of ultrasound‐guided cannulation is becoming more widespread in the setting of the “difficult‐to‐cannulate” AVA, which might include a new AVF in an elderly patient, an AVA with a history of multiple attempts to cannulate, a small caliber vessel, where there is an adjacent artery or nerve or in a vessel whose cannulation on the first attempt is critical. Ultrasound‐guided cannulation aims to improve first‐time successful cannulations and minimize cannulation‐associated complications . Patients who require multiple attempts at needle insertion or who experience major infiltration, bleeding or hematoma formation have increased dissatisfaction levels and prolonged dependency on CVC use, as well as increased healthcare cost through additional diagnostic tests and interventions …”

Ultrasound-guided cannulation of hemodialysis access

“…1). The majority of studies have used the transverse approach [9][10][11], and our preference is also this approach. Under transverse imaging, an operator can see the entire circumference of the vein and, thus, transverse imaging facilitates the cannulation of very small veins by enabling the operator to enter the vein right on the top of it.…”

“…On the other hand, the application of ultrasound-guided vascular access, which is now the standard in central venous access, has expanded to peripheral vessels [5][6][7]. Similarly, in the field of dialysis, there are growing indications for its use in cases of difficult peripheral dialysis vascular access, although the number of reports is still limited [8][9][10][11]. Even in Japan, where the prevalence of obesity is lower than in other countries, difficult AV fistula access has increased because of the epidemic of diabetes and aging of the dialysis population.…”