Cannulation and vascular access‐related complications in hemodialysis: Factors determining successful cannulation

Abstract

Little is known about cannulation of the vascular access (VA), such as the number of successful cannulation procedures, frequency of complications caused by cannulation, and VA failure. Incident patients were followed for 6 months, from the first successful cannulation with 2 needles--both used for the hemodialysis treatment. Data included patient characteristics, comorbidities, and medication. Vascular access characteristics included: type of VA and location, vein diameter assessed by Duplex ultrasound, length of the cannulation route, and maturation period. Longitudinal data were collected by dialysis nurses, using identical questionnaires, and a standardized method to register data from each dialysis session. Among 10 Dutch dialysis facilities, clinical data from 120 patients were collected from June 2005 to March 2007. The use of autogenous arteriovenous fistulae (P<0.001) and limited length of the cannulation route (P<0.003) negatively affect the outcome of cannulation and complications such as use of single-needle (SN) dialysis and central vein catheters (CVC). Previous use of CVC and SN hemodialysis were significant predictors for VA failure (P<0.0001). The present study demonstrated that during the first 6 months of a newly placed VA, a huge number of cannulation-related complications such as miscannulation, use of CVC, and SN dialysis are encountered. Despite the fact that guidelines recommended the arteriovenous fistulae as the preferred VA, cannulation-related complications can lead to increased morbidity. The length of the cannulation route positively correlates with successful cannulation. Therefore, adjusted cannulation techniques might be indicated to improve VA outcome.

Vascular Access Care and Treatment Practices Associated with Outcomes of Arteriovenous Fistula: International Comparisons from the Dialysis Outcomes and Practice Patterns Study

“…Furthermore, prior catheter use was also strongly associated with higher final AVF failure. This result is in agreement with prior reports [7,18,19]. The relationship of cancer with AVF failure differed considerably among the three regions, with a higher rate of primary and final AVF failure seen in North America and a higher rate of final AVF failure observed in Japan.…”

Achieving the Goal of the Fistula First Breakthrough Initiative for Prevalent Maintenance Hemodialysis Patients

“…For example, by implementing a program which included a dedicated vascular access nurse to coordinate patient care and an algorithm to prioritize AVF surgery, one dialysis facility documented an increase in AVF use from 56% to 75% 17. In the DAC study, 2% of non-maturing AVFs were referred for intervention to assist maturation before six weeks 18. Factors such as adequate length of the AVF cannulation segment and use of the buttonhole cannulation technique may reduce cannulation-related complications 19.…”

Use of Plastic Needles for Early Arteriovenous Fistula Cannulation

“…In the present study, patients who had AVFs punctured with a single plastic needle within 30 days from creation were compared with historical controls. Although single-needle dialysis is thought to be inferior, or is mentioned one that leads to complications [4] , it might be used uneventfully in a selected group of patients [9] . Previously, the technique was tested for first 6 treatments in incident patients.…”