Randomized pilot study to compare metal needles versus plastic cannulae in the development of complications in hemodialysis access

Abstract

Background:Hemodialysis requires needle insertions every treatment. Needle injury (mechanical or hemodynamic) may cause complications (aneurysms/stenosis) that compromise dialysis delivery requiring interventions. Metal needles have a sharp slanted “V”-shaped cutting tip; plastic cannulae have a dull round tip and four side holes. Preliminary observations demonstrated a difference in intradialytic blood flow images and mean Doppler velocities at cannulation sites between the two devices. Complications from mechanical and hemodynamic trauma requiring interventions were compared in each group.Materials and methods:In all, 33 patients (13 females and 17 new accesses) were randomized to metal group (n = 17) and plastic group (n = 16). Mechanical trauma was minimized by having five nurses performing ultrasound-guided cannulations. Complications were identified by the clinician and addressed by the interventionalists, both blinded to study participation. Patients were followed for up to 12 months.Results:Baseline characteristics were not significant. Procedures to treat complications along cannulation segments increased from 0.41 to 1.29 per patient (metal group) and decreased from 1.25 to 0.69 per patient (plastic group; p = 0.004). The relative risks of having an intervention (relative risk = 1.5, 95% confidence interval = 0.88–2.67) and having an infiltration during hemodialysis (relative risk = 2.26, 95% confidence interval = 1.03–4.97) were higher for metal needles. Time to first intervention trended in favor of plastic cannula (p = 0.069). Cost of supplies for these interventions was approximately CAD$20,000 lower for the plastic group.Conclusion:Decreased burden of illness related to cannulation (less infiltrations during hemodialysis) and Qb were associated with plastic cannulae. Decreased procedure costs were suggested during the study period in the plastic group.

First Reported Case of Neointimal Hyperplasia in the Midportion of a Polytetrafluoroethylene Dialysis Graft

“…It is unlikely that the intimal hyperplasic reaction could travel from the anastomoses to the midportion of the graft. This finding would most likely validate the proposed theory by Roy-Chaydhury et al 3 Marticorena et al 4 studied the use of metal needles versus plastic cannulas. They found that plastic cannulas had a lower rate of infiltration.…”

Analysis of experience of the use of plastic cannulas in Spanish haemodialysis units

“…Therefore, training ensures the preparation of competent nurses so that as a professional group, nursing will gain the visibility and social recognition that it deserves. Therefore, it is worth highlighting again the low prevalence of training among Spanish HD nurses in PC, which are presented in the literature as a beneficial innovation for people with VAs requiring HD (Marticorena et al, 2018).…”

“…At this moment, we should also mention that the procedure for inserting PC differs considerably from that of conventional metal needles. This can lead to difficulties for the nurses, who require training and special skills to modify the needle insertion technique (Marticorena, Dacouris, & Donnelly, 2018). The existing data in the literature does not provide accurate indications about the type of device that should be used for each VA and, therefore, the choice is determined by the needs of each workplace, the availability of the device and on nurses' experience or training (Parisotto, Pelliccia, & Bedenbender‐Stoll, 2016).…”

Influence of vascular access devices upon efficiency of therapeutic plasma exchange

“…Dialysis plastic cannulae are an alternative to traditional metal needles and are used during hemodialysis procedures. The main advantage of plastic cannulae vs metal needles are the reduced risk of mechanical (internal vessel damages) and hemodynamic (shear stress) complications . However, the usefulness of this device was never reported in TPE.…”

“…The main advantage of plastic cannulae vs metal needles are the reduced risk of mechanical (internal vessel damages) and hemodynamic (shear stress) complications. 3,4 However, the usefulness of this device was never reported in TPE.…”