What Nephrologists Need to Know about Vascular Access Cannulation

Abstract

This article describes cannulation events, especially problems, common and rare, minor and major, to aid the nephrologist (and mid-level providers e.g. nurse practitioner and physician's assistant) in decision-making to prevent or treat cannulation-related adverse outcomes. The usual management, potential outcomes, nephrologist intervention, and prevention are discussed and include: assessment of arteriovenous (AV) access and readiness for cannulation; initial cannulation of both arteriovenous fistulas and grafts; needle size and adequacy; needle direction and potential for recirculation; limited cannulation sites/buttonhole; pain and fear of pain; prevention of bleeding; management of infiltrations/extravasations; prevention and management of "one-site-itis"; prevention and management of infection. It concludes with the importance of the medical director as the leader of the continuous quality improvement (CQI) team in preventing/reducing cannulation-related adverse events.

Prospective multicenter study with a 1-year analysis of a new vascular graft used for early cannulation in patients undergoing hemodialysis

“…11,12 Thus, in the data analysis, the third consecutive cannulation was considered the marker for the end of catheter-dependent dialysis, even though some TDCs may have remained in place awaiting orders for or scheduling of removal.…”

The add-on effect of the Mutsu-Senshi® skin cooling device for needle insertion pain in hemodialysis patients: a multicenter prospective study

“…We also found that those using needles with larger diameter tended to rate Mutsu-Senshi® more favorably, and this factor was significant even in the multivariate regression analysis. Needle insertion pain is a considerable stress for patients receiving HD [4,5]. It may be associated with depressive symptoms and lower quality of life in patients with HD [19].…”

“…Pain associated with the insertion of dialysis needles can cause considerable stress on HD patients [4]. In fact, pain during needle insertion is the most common patient complaint regarding hemodialysis access [5].…”

Care of a Patient's Vascular Access for Haemodialysis: A Narrative Literature Review

“…Vascular access (VA) complications have been attributed to inadequate assessment, inappropriate cannulation practices and complications remaining undetected (Dinwiddie et al . ). Regular monitoring by skilled nephrologists and nurses utilising physical examinations is the cornerstone of VA surveillance programmes however, VA surveillance is the responsibility of everyone involved in the patient's VA care, which can include the patient and carer (Feddersen & Roger ).…”

“…Godbold (2013) defined carers as the patient's relative or friend whose role includes supporting the patient at home and or accompany them to haemodialysis therapy sessions, clinics and hospital. and complications remaining undetected (Dinwiddie et al 2013). Regular monitoring by skilled nephrologists and nurses utilising physical examinations is the cornerstone of VA surveillance programmes however, VA surveillance is the responsibility of everyone involved in the patient's VA care, which can include the patient and carer (Feddersen & Roger 2012).…”