Cannulation technique influences arteriovenous fistula and graft survival

Abstract

Hemodialysis patient survival is dependent on the availability of a reliable vascular access. In clinical practice, procedures for vascular access cannulation vary from clinic to clinic. We investigated the impact of cannulation technique on arteriovenous fistula and graft survival. Based on an April 2009 cross-sectional survey of vascular access cannulation practices in 171 dialysis units, a cohort of patients with corresponding vascular access survival information was selected for follow-up ending March 2012. Of the 10,807 patients enrolled in the original survey, access survival data were available for 7058 patients from nine countries. Of these, 90.6% had an arteriovenous fistula and 9.4% arteriovenous graft. Access needling was by area technique for 65.8%, rope-ladder for 28.2%, and buttonhole for 6%. The most common direction of puncture was antegrade with bevel up (43.1%). A Cox regression model was applied, adjusted for within-country effects, and defining as events the need for creation of a new vascular access. Area cannulation was associated with a significantly higher risk of access failure than rope-ladder or buttonhole. Retrograde direction of the arterial needle with bevel down was also associated with an increased failure risk. Patient application of pressure during cannulation appeared more favorable for vascular access longevity than not applying pressure or using a tourniquet. The higher risk of failure associated with venous pressures under 100 or over 150 mm Hg should open a discussion on limits currently considered acceptable.

The Hemodynamic Effects of Hemodialysis Needle Rotation and Orientation in an Idealized Computational Model

“…This opinion is in agreement with Parisotto et al. , who believe that needle rotation is unnecessary, and the technique may cause additional trauma to the blood vessel. It was also shown that a rotated needle draws 42% of the core flow through the back eye, whereas the inserted position draws 36%.…”

“…Focus has been directed at maintaining the patency of the vascular access . Cannulation technique has a large influence on some of the factors that affect patency but has received little attention.…”

Does the extracorporeal blood flow affect survival of the arteriovenous vascular access?

“…The recirculation values available for this study were all measured with the thermal dilution method, which measures the sum of cardiopulmonary recirculation and access recirculation, and so tend to be higher than pure VA flow measurements. On the other hand, recirculation values were measured, according to protocol, at Qb = 300 mL/min, and higher recirculation is probable at higher flows and depending on the cannulation technique exercised . Other possible explanations for why Qb >390 mL/min is associated with higher risk of AVF failure are related to needle size.…”

Anticoagulation, bleeding, and clotting at donor plasmapheresis

“…In hemodialysis patients with an arteriovenous fistula, prolonged bleeding usually ceases under extended pressure after 20–30 minutes. Therefore, a puncture‐technique changing the holes and inserting the needle with bevel‐up should be preferred . It is not known how many venous punctures will cause scars in plasma donors, but it would be an interesting question for further research in plasma donations, which may be limited because of obliterated veins by scarring (Figure ).…”