Cannulation of arteriovenous fistulae and grafts for dialysis

Is it feasible to compare two methods of needle insertions for use in kidney dialysis treatment?

“…Currently within the UK, it is estimated approximately 16,000 patients dialyse using an AV fistula or graft, with the majority using an AV fistula (as estimated from UK Renal Registry report (6)). However, despite the importance of AV fistulae use for haemodialysis, there remains significant challenges to its use, including service provision, maintaining function and cannulation (6)(7)(8).…”

“…Cannulation is required at each haemodialysis session and is critical for AV fistula use, but has significant challenges (7). Repetitive cannulation damages the AV fistula, causing failure through stenosis development.…”

“…Repetitive cannulation damages the AV fistula, causing failure through stenosis development. If the AV fistula fails or cannulation is unsuccessful, it can lead to CVC use, associated with increased mortality and morbidity (7,9,10). To preserve AV fistula function, 2 different cannulation techniques have developed ( 7):  Rope Ladder -this involves using a different cannulation site each time and progressing the cannulation sites up the vessel in a systematic manner.…”

“…Whilst both buttonhole and rope ladder cannulation are standard practice within the UK, both techniques are implemented inconsistently across the UK with protocols to implement techniques differing. This has created disagreement and debate within the renal community as to which is the better technique (7). Some units pre-dominantly using buttonhole and others rope ladder, dependant on clinician preference rather than evidence.…”

“…Patients want to know the advantages and disadvantages of both techniques, so they can make an informed choice based on data. The 'British Renal Society's Clinical Practice Recommendations for Cannulation of Arteriovenous Fistulae and Grafts' (7,20) are unable to provide evidence based recommendations on the optimal application of either technique, due to the poor quality of existing studies.…”