Point‐of‐care ultrasound use for vascular access assessment and cannulation in hemodialysis: A scoping review

Abstract

Point‐of‐care ultrasound (POCUS) for access assessment and guided cannulation has become more common in hemodialysis units. The aims of this scoping review were to determine: circumstances in which renal nurses and technicians use POCUS; the barriers and facilitators; and evidence of the effects of POCUS in guiding assessment and cannulation. A search was conducted of CINAHL, Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ProQuest, Trove and Google Scholar as grey literature sources. Of 1904 publications, 21 studies met inclusion criteria (11 full text and 10 abstracts). These included primary research publications (n = 5), clinical observational cohort studies (n = 5), case studies (n = 3), published guidelines (n = 2), and published position papers (n = 6). POCUS was used for: assessing arteriovenous fistula (AVF) maturation; identifying landmarks and abnormalities; assessing alternate cannulation sites; performing new AVF cannulation; performing difficult cannulation; increasing cannulation accuracy; performing cannulation through stents; and patient self‐cannulation training. There were scant data on the barriers to, and facilitators of the use of POCUS, and a distinct lack of empirical evidence to support its use. These knowledge gaps highlight the need for further clinical studies, particularly randomized clinical trials, to test the effectiveness of POCUS in hemodialysis for assessment and guided cannulation.

Direction- and Angle-Assisted Buttonhole Cannulation of Arteriovenous Fistula in Hemodialysis Patients: A Multicenter Randomized Controlled Trial

“…Ultrasound guided cannulation is probably the most documented and promising method for improved cannulation. A recent systematic review found 21 relevant published studies, but only 5 were primary research publications and the number of included patients was rather low (10). They concluded that there was a lack of robust studies, but ultrasound guided cannulation could probably increase the number of successful cannulations and reduce the risk of complications and misalignment of the needles.…”

“…A limited number of studies have suggested various methods and devices to improve AVF cannulation success rates. Point-of-care ultrasound-guided cannulation has reduced the number of miscannulations (10,11), but clinical uptake has been very limited and the technique is probably less useful for buttonholes. Other suggestions include implantable metal devices to guide the cannulation of deep fistulas, plastic cannulas, and cannulation maps and skin markings of the fistula, but the efficacy is in general not well documented (12)(13)(14).…”

POCUS-Punktion

“…In einer Übersichtsarbeit werden vielfältige Vorteile der POCUS-Punktion beschrieben 8 . Hervorzuheben sind die sichere Punktion der tief liegenden Shuntvene, die sichere Frühpunktion der neu angelegten AV-Fistel unter Verzicht eines ZVK oder das Erkennen von nicht geeigneten Punktionsorten, z.…”

“…„POCUS hat das Potenzial, die Punktionstechnik zu revolutionieren“ – diesen beeindruckenden Satz äußern Monika Schoch et al in der Zusammenfassung ihrer Übersichtsarbeit zur Nutzung von „point-of-care ultrasound“ bei der Shuntpunktion 8 .…”

Innovations to Increase Home Hemodialysis Utilization: The Transitional Care Unit

“…Other options include the use of ultrasound or marking the tract of the AVF. [29][30][31] Needle phobia or needle fear is a major barrier for patients toward home HD. 14 Peer support and observing other training patients place needles may help new patients.…”