Ultrasound guided cannulation of dialysis access

Abstract

Vascular access is the key part of haemodialysis (HD) treatment, as this is not possible without a functioning access. The use of the arteriovenous fistula (AVF) has fewer complications, lower mortality and fewer hospital admissions compared to central venous catheter (CVC). However, although guidelines recommend AVF as the access of choice, access-related cannulation complications may lead to greater morbidity. Most guidelines recommend using Doppler ultrasound (DU) to surveil the AVF for HD, but its use must not only be limited to surveillance as it can also be used for needling. Therefore, among those techniques at our disposal today, one of the best tools for AVF needling is Doppler ultrasound (DU). Despite the lack of evidence regarding ultrasound-guided needling of AVF, it is becoming part of our usual practice arsenal in many HD centres. Its use has allowed needling results to improve and the number of complications to be reduced versus traditional ‘blind’ needling. It should be remembered that even though it is very useful for the daily work of dialysis nurses, as in the case of other techniques, it requires adequate, specialised and long-term training to acquire competence in using it. For example, it is important to learn some concepts and terminology that should be known and, at the same time, be highly familiar with different techniques available. Two types of needling techniques are described using US assistance: US-guided needling, where DU is used to make a map of the vessels which can be utilised and to mark the best site to insert the needles once the mapping is done; and real-time US-guided needling, the simultaneous manipulation of the probe and the insertion of the puncture needle through the slice plane of the ultrasound device. Regarding the real-time technique, there are two approaches: out of plane (the probe takes a transversal image of the needle) and in plane (vessel axis aligned with the probe and the needle in the same plane) To ensure successful needling and to maximise reproducibility, especially with tight deadlines and staff resources, nursing staff need to follow some important recommendations that include safety and the use of the method, both for them and the patient. In this way, ultrasound-guided needling becomes a tool with enormous potential utility, but practical training is as important as knowing the technique.

Standardization of Pre-operative Evaluation to Improve the Outcome of Arteriovenous Fistula for Vascular Access of Hemodialysis: A Review of 700 Cases

“…Because of its safety, long-term effectiveness, and fewer issues than other techniques such as CVC and AVG, the National Kidney Foundation recommends AVF as the preferred access for long-term HD in patients with chronic or end-stage renal disease. As a result, creating a native AVF on the arm or forearm is a superior option to prosthetic grafts and CVC [ 5 , 8 , 9 ]. However, when HD is required urgently, and no other vascular access is available or has failed, CVC is the preferred method of temporary access [ 10 ].…”

Comparison of use of central venous catheter and arteriovenous fistula as initial vascular access in 735 patıents with end-stage renal disease

“…In HF patients, AVFs cannot be effectively used, and their risk of thrombosis is higher than normal population due to a low cardiac output. [22]. When these techniques are not vigorously complied, several morbid complications may occur, and vascular access may be lost [23].…”

Nurses' perceptions of point‐of‐care ultrasound for haemodialysis access assessment and guided cannulation: A qualitative study

“…The findings from this study can serve as valuable guidance for haemodialysis clinics planning to incorporate point-of-care ultrasound to enhance cannulation outcomes. used in the haemodialysis context (Iglesias et al, 2021;Marticorena et al, 2015;Niyyar, 2019;Onoue & Akiyama, 2021;Ward et al, 2017). However, none have explored via qualitative interviews the operator perceptions of using POCUS to gain a greater depth of understanding that may inform the uptake of POCUS.…”

“…This cannulation damage has the potential to lead to increased hospital admissions and costly radiological interventions. There is also risk that the AVF may completely thrombose, requiring surgical or radiological intervention, or complete access loss (Iglesias et al, 2021).…”

“…Recent studies on POCUS‐guided cannulation have assessed the effect of POCUS guidance on cannulation outcomes (Eves et al, 2020; Kumbar et al, 2018; Luehr, 2018; Nalesso et al, 2020; Niyyar et al, 2021), explored staff confidence with, and perceptions of, POCUS (Ward et al, 2017), and reported how POCUS is used in the haemodialysis context (Iglesias et al, 2021; Marticorena et al, 2015; Niyyar, 2019; Onoue & Akiyama, 2021; Ward et al, 2017). However, none have explored via qualitative interviews the operator perceptions of using POCUS to gain a greater depth of understanding that may inform the uptake of POCUS.…”