Effect of needle bevel position in arteriovenous fistula cannulation and bleeding during hemodialysis

Yılmaz, Üstün; Ünal, Aysun; cek, Esref; İnci, Ayça; Gul, Semih; rta, Gulay; Avci, Muammer; Sarıkaya, Metin

doi:10.5455/medscience.2022.07.156

Cited by 2 publications

(2 citation statements)

References 21 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Uston et al studied bevel position in conjunction with anticoagulant to examine the coagulation time in hemodialysis patients. It was found that the coagulation time of needle bevel down was shorter than that of needle bevel up [9]. David et al investigated venous needle flow to examine the fluid dynamic effects of cannulation by considering needle angle, blood flow rate, needle depth, and back eye.…”

Section: Introductionmentioning

confidence: 99%

A modeling study of position and orientation of hemodialysis needles and the impact on vascular access

Woraratsoontorn,

Bunmun

2024

J. Phys.: Conf. Ser.

View full text Add to dashboard Cite

Patients with chronic kidney disease (CKD) need renal replacement therapy (RRT) and the favored method is hemodialysis (HD). An arteriovenous fistula is the preferred choice of vascular access, with two metal needles used to transfer the blood with waste to the dialysis machine and return the blood without waste from the dialysis machine to the patient’s body. However, wounds on the veins can cause blood clots which if left untreated could be life threatening. The hemodialysis needles can cause vascular wall abnormalities. The position and orientation of these needles might cause intimal hyperplasia (IH) and finally lead to blood clots. This study aims to analyze the hemodynamic effects on the vascular endothelium in AVF vascular access. A 15G needle was placed inside a vein at angles of 20°, 40°, and 90° with normal insertion and flipped needle in an idealized cephalic vein with the bore of the needle centrally located, conforming to standard cannulation practice. The 3D model created by SolidWorks consists of shaft, back eye, bevel, and vein only; the vein and 15G needle were assembled together. The mathematical model of blood rheology in this paper used Carreau’s law in the fluid domain. It was imported into Ansys CFX for calculation, a finite volume based software, which was implemented to solve the governing equations of the blood flow. The result showed that if the venous needle was not towards the venous return, a vortex appeared at the vein both upstream and downstream due to the venous needle, resulting in wall shear stress at the vein increasing significantly, and the flipped bevel seems to cause higher wall shear stress. For antegrade positioning of the vein vascular access return in the model when normally inserted, it was found that only 1% of the flow out of the back eye and vortex occurred downstream of the vein. Needles placed at a higher angle can increase wall shear stress and pressure on the vein. The flipped bevel is not significant in terms of either pressure or wall shear stress. However, when the needle is placed at a greater angle, wall shear stress and pressure on the vein were also increased. The flipped bevel caused higher wall shear stress and pressure when increasing the needle angle. Jetting from the venous needle causing intimal hyperplasia (IH) leads to blood clots, pain on the vein, and ultimately arm pain. Thus, the best cannulation procedure is for the venous needle to be toward the venous return, at a lower angle, and with the tip of the needle on the middle of the vein. Furthermore, the back eye should not be used for the venous needle but should be used for the arterial needle.

show abstract

Section: Introductionmentioning

confidence: 99%

A modeling study of position and orientation of hemodialysis needles and the impact on vascular access

Woraratsoontorn,

Bunmun

2024

J. Phys.: Conf. Ser.

View full text Add to dashboard Cite

show abstract

“…Hemodialysis patients with an arteriovenous fistula (AVF) or arteriovenous graft (AVG) are at increased risk of bleeding due to the coagulopathy of end-stage kidney disease [ 1 ] and the use of systemic anticoagulation in the hemodialysis circuit [ 2 ]. The risk of prolonged bleeding specifically after needle removal from AVF or AVG cannulation sites is also impacted by needle position [ 2 , 3 ] cannulation technique (buttonhole versus rope-ladder) [ 4 ], vascular access integrity, namely whether there is associated pseudoaneurysm/aneurysm, stenosis or infection [ 5 ]. Prolonged post-cannulation bleeding is associated with poor outcomes including increased rates of anemia [ 6 ], quality of life disruptions [ 7 ], and fatal catastrophic hemorrhage [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Non-surgical interventions to control bleeding from arteriovenous fistulas and grafts inside and outside the hemodialysis unit: a scoping review

Milosevic,

Forster,

Moist

et al. 2024

Clinical Kidney Journal

View full text Add to dashboard Cite

Background Prolonged bleeding from arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) associates with worse outcomes; Within the hemodialysis unit these outcomes include anemia and quality of life disruptions, and outside the hemodialysis unit includes fatal hemorrhage. However, various guidelines for AVF/AVG bleeding management inside and outside the hemodialysis unit lack consensus. Methods A scoping review was conducted of four databases, from inception to February 17 (2024). The study population was hemodialysis patients experiencing bleeding from AVF or AVG. Studies that assessed non-operative management were included. Results Sixteen studies met inclusion criteria. Most (14/16) addressed post-cannulation bleeding from AVF/AVG within the dialysis unit. Compared to standard dressings, hemostatic dressings (Chitosan, cellulose, or thrombin-based) decreased post-cannulation bleeding time at arterial and venous site 35.7-84.0% (p<0.05) and 38.5-78.7% (p<0.05), respectively. Use of Chitosan-based dressings decreased percentage of patients bleeding 4 minutes post-cannulation by 16.3 to 39.2%. One pilot observational study demonstrated no access thromboses or infections with short-term use of a compression device within the hemodialysis unit. However, the role of compression devices and tourniquets within the dialysis unit remains unclear, despite widespread use. Long-term AVF/AVG survival was not reported in any study. Limited research confirms that devices are effective in prevention of catastrophic out-of-hospital bleeding. It remains uncertain if device availability enhances patient confidence in managing out-of-hospital bleeding. This may impact patient choices around dialysis modality, access and transplant, but this remains uncertain. Conclusions In hemodialysis patents with bleeding from AVF/AVG, several alternative dressings or devices decrease post-cannulation bleeding time within the hemodialysis unit. Existing research has not established criteria on when it might be appropriate to use specialized dressings. There is very limited research on methods to control bleeding from AVF/AVG outside the hemodialysis unit. More data is required before evidence-based guidelines can be made. Recommendations for future research are provided.

show abstract

Effect of needle bevel position in arteriovenous fistula cannulation and bleeding during hemodialysis

Cited by 2 publications

References 21 publications

A modeling study of position and orientation of hemodialysis needles and the impact on vascular access

A modeling study of position and orientation of hemodialysis needles and the impact on vascular access

Non-surgical interventions to control bleeding from arteriovenous fistulas and grafts inside and outside the hemodialysis unit: a scoping review

Contact Info

Product

Resources

About