Abstract
Because hemodialysis therapy cannot be performed without the cannulation of a vascular access, establishing a well-functioning vascular access is crucial. Recently, the number of patients with difficult arteriovenous (AV) fistula cannulation has increased due to changes in the epidemiology of the dialysis population. To address this issue, indications for real-time ultrasound-guided techniques have recently been reported. This review discusses methods of ultrasound-guided cannulation of dialysis access; it is difficult to cannulate a deep, small, or stiff vessel of an AV fistula on the first attempt with static ultrasound guidance in which the ultrasound probe remains stationary. Mastering a method in which the precise location of the needle tip can be continuously identified during the insertion by dynamic probe scanning is required. To achieve this, understanding the theory of ultrasound guidance, off/on-the-job training, and a sense of professionalism are important. The use of ultrasound also enables the safe catheter placement into a collapsed central vein and repeated direct puncture of a femoral vein. The latter reduces the risk of catheter-related blood stream infection by avoiding the use of an indwelling dual-lumen catheter. In conclusion, ultrasound-guided techniques enable precise vascular cannulation, which can result in significant patient and financial impact. The accumulation of further reports is required for the method to be acknowledged as the standard to cope with difficult vascular access for dialysis. As most of the latest ultrasound machines for procedural guidance are optimized for peripheral nerve block, a compact and affordable ultrasound device with image quality focused on vascular access is also needed.
Highlights
The creation and maintenance of a well-functioning vascular access are crucial for efficient hemodialysis therapy
Ultrasound-guided vascular access can be an effective method in continuing adequate hemodialysis therapy for some patients
The accumulation of further reports is required for the method to be acknowledged as the standard to cope with difficult AV fistula access
Summary
The creation and maintenance of a well-functioning vascular access are crucial for efficient hemodialysis therapy. There is a report that an ultrasound-guided technique significantly improved the success rate, reduced the number of attempts, and decreased the incidence of complications related to femoral venous dialysis catheter insertion [26], the first-attempt success rate under ultrasound guidance in this study was still 85 % This is at least in part because femoral veins are located under a hyperechoic heterogeneous subcutaneous tissue, resulting in difficulty visualizing the needle tip directly on the ultrasound screen, like peripheral veins. If the tip reaches the anterior wall, tenting of the vein appears, which is a helpful sign Utilizing those methods, 16 patients underwent blood purification by repeated ultrasound-guided femoral vein puncture until either peripheral vascular access was established or blood purification was withdrawn [27]. Video output sockets (both digital and analog) are needed to record the ultrasound screen on video from an educational point of view, as stated in the “Training method” section
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