Use of Plastic Needles for Early Arteriovenous Fistula Cannulation

Letachowicz, Krzysztof; Kusztal, Mariusz; Gołębiowski, Tomasz; Letachowicz, Waldemar; Weyde, Wacław; Klinger, Marian

doi:10.1159/000437043

Cited by 12 publications

(18 citation statements)

References 13 publications

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“…Plastic cannulae have a symmetric round tip and four side holes within 0.5 cm from the tip and a 15G shaft ( Figure 1 ). Plastic cannulae are used during the first 2–4 weeks of cannulation of new or complex accesses for their lower risk of infiltration compared to metal needles; 11 , 13 , 14 , 17 , 18 their use can be extended in patients with high risk of infiltration. The primary reason to transition cannulae to metal needles is cost; they are 2–3 times more expensive than metal needles.…”

Section: Introductionmentioning

confidence: 99%

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

2018

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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.

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Section: Introductionmentioning

confidence: 99%

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

2018

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“…Ultrasound mapping of potential cannulation sites and ultrasoundguided cannulation in selected cases played an important role in the success of this study. 37,38 The use of plastic needles was also felt to contribute to the success of early cannulation 39,40 although not felt to be necessary in all patients, especially after the initial month of access use.…”

Section: Resultsmentioning

confidence: 99%

Early cannulation of percutaneously created arteriovenous hemodialysis fistulae

2019

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Introduction: The optimal vascular access for most dialysis patients is an arteriovenous fistula and the recognized appropriate process of care for the chronic kidney disease patient is to have the access in place ready for use when renal replacement therapy is required. Unfortunately, as a result of multiple barriers, most patients start dialysis with a catheter and many experience multiple interventions. The recent advent of the percutaneous arteriovenous fistula may offer at least a partial solution to these problems. The purpose of this study was to report of the results of early cannulation of the percutaneous arteriovenous fistula. Materials and Methods: Early cannulation, less than 14 days post creation, was performed in 14 cases in order to avoid an initial catheter or continued use of a problematic catheter for dialysis. Immediately post access creation, blood flow ranged from 491 to 1169 mL/min (mean = 790 mL/min). Ultrasound was used to map potential cannulation sites prior to use. Cannulation was performed using plastic fistula cannulas. Results: Early cannulation was successful in this cohort of cases except for one cannulation complication. Dialysis treatments were otherwise uncomplicated. Primary patency at 3, 6, and 12 months was 76%, 76%, and 66%, respectively. Assisted primary patency for the same intervals was 100%, 100%, and 91%, respectively. Cumulative patency was 100% at all three-time intervals. Conclusion: The results of this study suggest that the possibility of successful early cannulation with a percutaneous arteriovenous fistula can be considered as an additional factor in making this access a reasonable alternative for a surgically created arteriovenous fistula in appropriate patients.

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“…The above-mentioned study by Letachowicz et al (13) demonstrated successful cannulations with plastic cannulae in newly created AVF, without a negative influence on access survival. The authors stated that the study is limited by the small sample groups, not being randomised and by not including ultrasound-guided cannulations.…”

Section: Cannulation Of Newly Created Avfmentioning

confidence: 93%

“…A retrospective study carried out by Letachowicz et al (13) in a Polish dialysis unit compared the development of haematoma in 20 patients punctured with plastic cannula (17-gauge) with 19 patients punctured with metal needles (16-gauge). All patients had a newly created AVF and cannulations were performed within the first 30 days after creation.…”

Section: Needle or Plastic Cannula For Nocturnal Dialysismentioning

confidence: 99%