Vascular Access Cannulation in Hemodialysis Patients – A Survey of Current Practice and its Relation to Dialysis dose

Gauly, Adelheid; Parisotto, Maria Teresa; Skinder, Aleksandra; Schoder, Volker; Furlan, Andreja; Schuh, Erika; Marcelli, Daniele

doi:10.5301/jva.2011.8413

Cited by 22 publications

(23 citation statements)

References 12 publications

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“…Studies in which the distance between puncture needles was analyzed do not describe how distance was measured. 17,21 In our study, the vascular access with the shortest distance between the needles was AVF (93%), proximal (55%), and with anterograde cannulation (98%). These characteristics suggest that fistulas probably had smaller extension for cannulation.…”

Section: Tablementioning

confidence: 60%

“…Several results of our study are in agreement with those reported by others. Gauly et al 17 , in 2011, published an extensive multicenter study involving 10,807 patients from 171 Fresenius Medical Care clinics, in nine European countries and South Africa. Table 7 shows the main features of cannulation techniques observed in that study compared to our results.…”

Section: Discussionmentioning

confidence: 99%

“…In relation to these variables, Gauly et al reported that there is great variation among dialysis units, possibly because the local routine influence the technique. 17 Regarding the diameter of the needles, 17G needles are the most used for new fistulas. When the AVF is mature, 14, 15, or 16G needles can be used, being the choice guided by the blood flow in the extracorporeal circuit.…”

Section: Tablementioning

confidence: 99%

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Vascular access cannulation in hemodialysis patients: technical approach

et al. 2020

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Introduction: The vascular access cannulation technique varies among clinics, and guidelines on vascular access give little importance to cannulation techniques. The objective of this study was to evaluate the cannulation technique and to determine which factors are associated with each detail of the technique. Material and methods: The vascular access cannulation was evaluated in 260 patients undergoing hemodialysis. The type and anatomical location of the vascular access, the cannulation technique, direction, gauge, and distance between needles, besides bevel direction and needle rotation were registered. Results: The arteriovenous fistula was the most frequent vascular access (88%), the most used cannulation technique was area (100%), the needle direction was anterograde in most cases (79.5%), and the mean distance between the tips of needles was 7.57±4.43 cm. For arteriovenous grafts, the proximal anatomical location (brachial artery) and cannulation with 16G needles in anterograde position were more predominant. For arteriovenous fistulas, the distal anatomical location (radial artery) and cannulation through 15G needles were more common. Cannulation of vascular access in retrograde direction was associated with a greater distance between needles (13.2 ± 4.4 vs 6.1 ± 3 cm, p < 0.001). Kt/V was higher when the distance between needles was higher than 5 cm (1.61 ± 0.3 vs. 1.47 ± 0.28, p < 0.01). Conclusions: The vascular access cannulation technique depends on the vascular access characteristics and expertise of cannulators. Clinical trials are required for the formulation of guidelines for vascular access cannulation.

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Section: Tablementioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Tablementioning

confidence: 99%

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Vascular access cannulation in hemodialysis patients: technical approach

et al. 2020

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“…Conversely, the findings of this study disagree with the conclusion made by previous studies stating that there was no significant difference in dialysis adequacy parameters between antegrade and retrograde arterial needle placement [11,[13][14][15][16]18]. Furthermore, the findings of this study are incongruent with the conclusions drawn from previous study that revealed that the retrograde placement of the arterial needle had a significantly higher probability to attain Kt/V of 1.20 and that retrograde with a needle distance of 10 cm or more presented the best Kt/V values [12,19]. In addition, English reported a small advantage to retrograde insertion showed that the retrograde direction of placement of the arterial needle was proposed to improve dialysis adequacy and recommended to be used more frequently in the dialysis setting [20].…”

Section: Discussionmentioning

confidence: 53%

“…On the other hand, Molaei et al revealed that the recirculation rate had a significant relationship with the direction of needle placement and the space between two arteriovenous fistula needles [31]. As supported by the claim of Gauly et al that enlarging the distance between bevels of the arterial and venous needles decreases access recirculation [19].…”

Section: Discussionmentioning

confidence: 99%

Effects of Arterial Needle Placement in Arteriovenous Fistula on Dialysis Adequacy of End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis

2016

JNH

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Objective: The arterial needle placement in arteriovenous fistula (AVF) can either be antegrade (in the direction of blood flow or pointing towards the heart) or retrograde (against the direction of blood flow) while venous needle placement should always be in the same direction as the blood flow. This study determined the effects of arterial needle placement in the arteriovenous fistula on dialysis adequacy of End-Stage Renal Disease (ESRD) patients undergoing maintenance hemodialysis in United Candelaria Doctors Hospital - Nephro Synergies Inc. (UCDHNSI) Hemodialysis Center. Methods: A randomized controlled trial design was used in the study. A total of 20 non-diabetic, non-cardiac patients on maintenance hemodialysis for more than 6 months were randomized either to the intervention group (patients’ AVF were cannulated in a retrograde manner) or the control group (patients’ AVF were cannulated in an antegrade manner). Urea reduction ratio (URR) and Kt/V as well as access recirculation percentage were used to determine dialysis adequacy. Pre-dialysis, in the first 30 minutes of dialysis initiation and post-dialysis blood samples were obtained in each patient in 6 succeeding hemodialysis considering dialyzer reuse up to fifth reuse. Means were compared by independent t-test. Results: The findings of the study revealed that the mean URR and Kt/V of the subjects cannulated in retrograde manner and antegrade manner were 69.35% and 1.45, and 74.65% and 1.70, respectively. The mean access recirculation percentage of the subjects was 4.65% in the intervention group and 3.02% in the control group. There was a significant difference on URR and Kt/V of the subjects using retrograde and antegrade arterial needle placement in 6 succeeding hemodialysis sessions. There was no significant difference on access recirculation percentage of the subjects using retrograde and antegrade arterial needle placement in 6 succeeding hemodialysis sessions. Conclusions: Antegrade arterial needle placement provides more adequate hemodialysis than retrograde arterial needle placement in terms of URR and Kt/V values among non-diabetic, non-cardiac patients undergoing maintenance hemodialysis in 6 succeeding hemodialysis sessions. The directions of the arterial needle either retrograde and antegrade did not have significant effects on access recirculation.

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