Arteriovenous Fistula Cannulation Research Articles

Arteriovenous fistula cannulation in hemodialysis: Constructing and validating a decision-making model

Arteriovenous fistula cannulation in hemodialysis: Constructing and validating a decision-making model

Cause analysis and nursing management of 1 case of osteofascial compartment syndrome after first-time cannulation of arteriovenous fistulas

Cause analysis and nursing management of 1 case of osteofascial compartment syndrome after first-time cannulation of arteriovenous fistulas

Needle Direction and Distance of Arteriovenous Fistula Cannulation in Hemodialysis Adequacy; a Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to summarize the evidence regarding the impact of needle direction and distance of arteriovenous fistula (AVF) cannulation on KT/V (where k is the dialyzer urea clearance, t, the duration of dialysis, and V, the volume of distribution of urea) and access recirculation (AR) as hemodialysis (HD) adequacy criteria. A comprehensive systematic search was performed on international and domestic electronic databases from the earliest to June 4, 2022 using keywords. Analysis was performed in STATA software v.14. Three randomized control trials (RCTs) and four non-RCT articles were included in the final review. Six studies reported the effects of direction, while four mentioned the effects of distances of AVF cannulation on outcomes of HD adequacy based on KT/V or AR. Results of three non-RCT studies showed that retrograde direction decreased KT/V more than antegrade direction (ES: 0.44, 95% CI: -0.38 to 1.27). Two non-RCT studies showed that antegrade decreased AR compared to the retrograde direction (ES: -0.64, 95%CI: -1.94 to 0.67). However, the results of two RCTs indicated uncertainty about this issue. Two of the four studies suggested that a distance of 5 cm or more in arterial and venous needles had greater adequacy than a distance of less than 5 cm. However, other studies did not confirm this finding. Overall comparison of the results qualitatively and quantitatively indicated uncertainty about the effects of direction and distance of AVF cannulation on HD adequacy outcomes. More studies with high-quality designs, such as RCTs, are required to better understand and adjudicate the effects of needle direction and distance of AVF cannulation on HD adequacy outcomes.

The Effect of Acupressure and Cryotherapy on the Pain of Patients on Hemodialysis During Arteriovenous Fistula Cannulation: A Randomized Crossover Clinical Trial

The Effect of Acupressure and Cryotherapy on the Pain of Patients on Hemodialysis During Arteriovenous Fistula Cannulation: A Randomized Crossover Clinical Trial

Comparison of prilocaine/lidocaine cream with piroxicam gel for reducing pain during cannulation of arteriovenous fistula for adults undergoing haemodialysis: A randomized crossover clinical trial.

Pain is a traumatic experience for most patients on hemodialysis. In this trial, we compared prilocaine/lidocaine cream with piroxicam gel for pain reduction during arteriovenous fistula needling. This randomized double-blind crossover clinical trial was done at dialysis unit of a tertiary care hospital from June to August 2022. Adult patients, aged 18-75 years, on maintenance hemodialysis through an arteriovenous fistula were selected randomly. Pain severity during needling of fistula was assessed during initial two hemodialysis sessions without application of any drug. Patients were then randomized into two groups receiving 5% prilocaine/lidocaine cream or 0.5% piroxicam gel 1 h before the next two hemodialysis sessions. After a 7-day washout period, patients crossed over to other groups for another two hemodialysis sessions. Pain was assessed on all these occasions. Primary outcome was reduction in pain with each intervention. There were 32 patients aged 46.44 ± 11.58 years. Pain intensity was 6.69 ± 0.58, 3.13 ± 1.28, and 4.55 ± 1.95 without any medication, prilocaine/lidocaine cream and piroxicam gel respectively. There was greater pain reduction with prilocaine/lidocaine cream than piroxicam gel (3.56 ± 1.35 vs 2.14 ± 1.78; p = 0.001). Local redness with prilocaine/lidocaine cream was reported by one (3.13%) patient, whereas no side effects were seen with piroxicam gel (p = 1.000). Prilocaine/lidocaine cream provides better pain relief than piroxicam gel during arteriovenous fistula needling.

Preconditions that facilitate cannulation in arteriovenous fistula: A mixed-methods study.

Nurses have a great responsibility in the daily care of arteriovenous fistulae, which entails the potential to affect patency. However, good cannulation technique involves more than placing a needle in the vessel and relies on different skills to facilitate needling. To describe the preconditions for cannulation in arteriovenous fistulas. Descriptive statistics and qualitative content analysis were used in a mixed-methods design. Haemodialysis units in Sweden. Local guidelines regarding arteriovenous fistula cannulation were analysed in parallel with responses to a questionnaire that contained open-ended and closed-ended questions on cannulation technique. Preconditions that facilitate cannulation fall into five stages, each with relevant factors in relation to the cannulation, as follows: planning cannulation-maturation and planning the cannulation, patient record, education and experience, and patient information; precannulation-physical examination, hygiene routines, arm position, tourniquet, choosing the cannulation site, and preventing pain; during cannulation-how to needle, type of needle, angle during cannulation, fixation, and adjusting; evaluating cannulation-blood flow rate and arterial and venous pressure; and postcannulation-needle withdrawal and haemostasis. The majority of dialysis units identified implementation of most of these preconditions, but the units handle several practical aspects differently. Tracing the chain of cannulation led to identification of necessary preconditions for facilitating good cannulation technique. The findings also show the need for a better understanding of how different preconditions affect arteriovenous fistula and patency.

Effect of the arterial needle bevel position on puncture pain and postremoval bleeding time in hemodialysis patients: A self-controlled, single-blind study.

This study aimed to investigate the effect of the bevel orientation (facing upwards or downwards towards the skin) of the needle inserted into the arterial limb of the arteriovenous fistula (AVF) on puncture pain and postremoval bleeding time. This study, using a single-blind crossover design, was conducted on 35 maintenance hemodialysis patients who had been dialyzed for at least 6months and in whom blood access was via an AVF. AVF cannulation was performed with the needle bevel pointing upward in the first six sessions and the needle bevel pointing downwards (towards the skin) in the subsequent six sessions. Needles were always inserted in the direction of blood flow. At each dialysis session, cannulation pain was measured using a visual analog scale (VAS), and the bleeding time at the end of dialysis after needle removal was recorded. The VAS score and postremoval bleeding time were lower when the needle bevel pointed downwards towards the skin during insertion (P<0.05). Insertion of the needle with the bevel pointed downward decreased puncture pain during cannulation and bleeding time postdialysis on needle removal.

Comparison of the Effect of EMLA™ Cream and the Valsalva Maneuver on Pain Severity during Vascular Needle Insertion in Hemodialysis Patients: A Controlled, Randomized, Clinical Trial.

Background Pain due to vascular needle insertion has been reported in 40–60% of hemodialysis (HD) patients. Evidence suggests that there is typically no single method for relieving the pain of inserting vascular needles in HD patients. This study aimed to compare the effectiveness of EMLA cream and Valsalva maneuver (VM) on pain severity during vascular needle insertion in HD patients. Methods This randomized, controlled, clinical trial was conducted on 90 patients undergoing hemodialysis in the hemodialysis unit of Kowsar Hospital, affiliated with Semnan University of Medical Sciences, in Semnan, Iran. Patients were selected via convenience sampling and were randomly assigned to one of the three groups (EMLA, VM, and control groups). For the patients in the EMLA group, 2.5 g of EMLA cream was applied 60 minutes before the start of dialysis. For patients in the VM group, a maneuver was performed for 16–20 seconds before the needle was inserted. Patients in the control group received only routine care without any additional interventions. The pain severity in the three groups was measured using the visual analog scale (VAS) two minutes after vascular needle insertion. Results The results showed that the mean pain severity during cannulation was 2.06 ± 2.19 in the EMLA group, 3.2 ± 30.42 in the VM group, and 6.20 ± 1.49 in the control group, suggesting a significant difference between the groups (P < 0.001). Pairwise comparison of the mean pain severity showed that it differed significantly in the EMLA and VM groups from the control group (P < 0.001), but no significant difference was found between the EMLA and VM groups (P=0.067). Conclusion According to the results, EMLA cream was as effective as VM in reducing the pain severity caused by arteriovenous fistula (AVF) cannulation. Therefore, the use of EMLA cream and VM is recommended for reducing the severity of AVF cannulation pain. Trial Registration. Iranian Registry of Clinical Trials, Trial No : IRCT20120109008665N12, registered on 3 June 2020.

Assessment of Nurses Performance regarding Arteriovenous Fistula Cannulation and Suggested Guidelines for Prevention of its Failure

Assessment of Nurses Performance regarding Arteriovenous Fistula Cannulation and Suggested Guidelines for Prevention of its Failure

MO786: Monitoring of Arterio-Venous Fistula Maturation using Central-Venous Oxygen Saturation and Estimated Upper-Body Blood Flow: Impact on Catheter Residence Time

Abstract BACKGROUND AND AIMS In hemodialysis patients, assessment of arterio-venous fistula (AVF) maturation is key to reduce the residence time of central venous catheters (CVC). We have introduced the use of central-venous oxygen saturation (ScvO2) and estimated upper-body blood flow (eUBBF) as means to monitor AVF maturation [1]. We now report CVC residence time in patients with and without ScvO2-based AVF maturation monitoring. METHOD We studied hemodialysis patients in who ScvO2-based AVF maturation monitoring was implemented within the framework of a clinical quality improvement project (QIP). ScvO2 and hematocrit were measured with Crit-Line (Fresenius Medical Care, Waltham, MA). eUBBF was computed as described previously [1]. We used time-to-event analysis to compare the CVC residence time post-AVF creation between patients who participated in the QIP (intervention group) and non-QIP patients (control group). Both groups were dialyzed in the same geography. Patients were censored at the time of death, change of dialytic modality, transplantation, lost to follow up, recovery of kidney function and end of the observation period (15 November 2021). RESULTS The intervention group comprised 44 patients [age 57 ± 17 years; 27 (61%) males]. In five patients, two AVF were created; in 34 (69%) CVC were removed. The control group comprised of 378 patients (age 59 ± 15 years, 61% males). CVC was removed in 199 (53%) control patients. In the intervention group, CVC were removed 125 days [95% confidence interval (95% CI): 102–171] after AVF creation. In the control group, this time was 236 days (95% CI: 173–404) (P &amp;lt; 0.0003; log rank test; Figure). CONCLUSION Compared to controls, the CVC residence time post AVF-creation was shortened significantly— by about 3.6 months—in patients who participated in a QIP that used ScvO2-baseed assessment of AVF maturation. Measurement of ScvO2 and computation of eUBBF are simple, non-invasive means to track AVF maturation, trigger timely interventions and AVF cannulation and shorten CVC residence time.

Assessment of Pain and Anxiety During Arteriovenous Fistula Cannulation Among Hemodialysis Patients: A Cross-Sectional Study in Saudi Arabia.

BackgroundThe number of hemodialysis patients has dramatically increased over the years. The cost of healthcare provision to those patients has been rising as well. In addition, pain management during arteriovenous fistula (AVF) cannulation is an important aspect of nursing care. Patients’ outcomes and appropriate pain control are one of the most critical issues in healthcare.PurposeTo measure the level of pain and anxiety associated with arteriovenous fistula cannulation among hemodialysis patients.MethodsA correlational cross-sectional research design was used in this study at the Hemodialysis Unit at King Fahad Hospital of the university, Al-Khobar, in the Eastern region of the Kingdom of Saudi Arabia using a self-administered questionnaire. Ethical approval was obtained. A convenience sample of 117 HD patients from the previous mentioned setting were included in the study. The data were collected using three tools: sociodemographic characteristics, Numerical Analogue Scale (NAS), and Hospital Anxiety and Depression Scale (HADS). Using IBM SPSS software package version 25.0, statistical significance of the obtained results was judged at the 5% level.ResultsAccording to the results, most of the participants experienced a mild to moderate level of pain and anxiety during arteriovenous fistula cannulation. Furthermore, there was a positive association between the level of pain and anxiety, with statistical significance (p<0.001).ConclusionBased on the results of the study, most of the study participants’ level of pain and anxiety during AVF cannulation ranged between mild and moderate.

Bridge of Tunneled Cuffed Catheter as a Risk for Future Arteriovenous Fistulae Failure.

Background: A clinically tunneled cuffed catheter (TCC) for hemodialysis (HD) is often inserted into end-stage renal disease patients, who have an immature or no arteriovenous fistula (AVF), for the performance of HD to relieve uremic syndrome or to solve uncontrolled fluid overload, hyperkalemia, or metabolic acidosis. The catheter is primarily regarded as a bridge until the AVF matures and can be cannulated for HD. However, the effect of the bridge of the TCC on the future patency of AVFs remains elusive. Methods: This nationwide population-based observational study compared the hazards of AVF failure and the time to AVF failure. We enrolled 24,142 adult incident patients on HD, who received HD via AVFs for at least 90 days between 1 January 2010 and 31 December 2015. The subjects were divided into two groups, according to the history of TCC, and were followed-up until the failure of the AVF, mortality, or the end of the study. A propensity score-matched analysis based on 1:1 matching of age, sex, and baseline comorbidities was utilized to reduce bias and confounding variables. Results: A Kaplan–Meier survival curve revealed that patients with and without a history of TCC had significantly better AVF survival rates (log-rank test; p < 0.001). A history of TCC was independently associated with a higher risk of new AVF or AVG creation due to AVF failure, after the adjustment of the Charlson comorbidity index score (corresponding adjusted hazard ratios of 2.17 and 1.52; 95% confidence intervals of 1.77–2.67 and 1.15–1.99). For the impact of time on AVF failure, patients with a TCC bridge had a significantly higher incidence of new AVF creation during the first year after the AVF cannulation. Conclusion: A history of a TCC bridge was an independent risk factor for AVF failure and the time of AVF failure was significantly higher during the first year after the fistula cannulation in the TCC bridge group.

Point-of-care ultrasound-guided cannulation versus standard cannulation in hemodialysis vascular access: A controlled random order crossover pilot feasibility study.

Standard cannulation practice for hemodialysis consists of inserting needles "blindly" through skin into an arteriovenous fistula (AVF), which is more likely to cause damage. Point-of-care ultrasound (POCUS) guided cannulation has potential for less damage; however, efficacy of this technique has not been explored. Our purpose was to test the feasibility and effectiveness of POCUS guidance for cannulation of AVFs in hemodialysis patients. A random-order crossover research design was used; patients and nurses acted as their own control. Sample included 13 patients with functioning AVFs and 9 nurses, recruited from a single hemodialysis center. All nurses cannulated all patients using standard and POCUS-guided cannulation. Data were collected at each cannulation (time taken, nurse position, probe direction, pressures, patient satisfaction, pain scores). Ultrasound images of needle position were collected from which needle tip locations inside vessels were measured. Nurses were surveyed at three timepoints and were interviewed at conclusion of data collection. Analysis involved linear mixed-models for clinical data, descriptive statistics for binary and feasibility data, and content analysis for interview data. Eleven patients and seven nurses completed. Protocol adherence was 94.4%. Two miscannulations occurred, both during standard cannulation. Cannulation time using POCUS guidance was significantly higher than standard cannulation (p = 0.008, 95% CI 39-166). All other variables showed no statistically significant difference. Content analysis of interview data showed cultural shift toward use of POCUS; nurses gained confidence and become more proficient in their POCUS technique. Random-order crossover is a feasible design to measure differences in POCUS-guided and standard cannulation. It is also feasible to implement POCUS into hemodialysis centers and whilst POCUS guidance takes longer, nurses become more proficient, and confident with persistent use.

Impact of cryotherapy on arteriovenous fistula cannulation - oriented discomfort in hemodialysis patients at designated dialysis centres in Solapur, Maharashtra

Pain during arteriovenous fistula (AVF) cannulation continues to be a significant issue in hemodialysis (HD) patients, leading to non-compliance with lifetime maintenance HD. The purpose of this study was to see if cryotherapy could reduce discomfort during AVF cannulation in HD patients at a tertiary care hospital in Solapur, Maharashtra. This is experimental research involving 63 patients undergoing HD by AVF. The patients were randomly assigned to two groups: experimental (got cryotherapy) or control (did not get cryotherapy). Used the Wong-Baker pain rating scale version to calculate the pain score. The experimental group had a significant difference in pre-and post-intervention pain levels, but the control group had no difference. Based on a P 0.05. Rejected the null hypothesis. Our findings imply that cryotherapy is an effective treatment for AVF cannulation-related discomfort in adult patients undergoing HD. As a result, cryotherapy is suggested to be investigated as a supplementary technique to alleviate pain associated with AVF cannulation.

Effect of needle bevel position in arteriovenous fistula cannulation and bleeding during hemodialysis

This study investigated the effect of needle bevel position during arteriovenous fistula cannulation on bleeding stop time in patients with chronic hemodialysis. An arteriovenous fistula puncture was performed on patients using the needle bevel up and down and the bleeding stop time was recorded in minutes. The outcomes of the two techniques were compared. The anticoagulant type used did not affect the bleeding stop time in the 55 patients with hemodialysis included in this study. On separately considering puncture outcomes and anticoagulant type used, the bleeding stop time in both arterial and venous needle bevel down punctures was found to be significantly lower compared with the bevel up puncture (p&lt;0.05). The bleeding stop time was found to be shorter in bevel down arteriovenous fistula puncture.

Nurses' Use of Ultrasound Location for Puncturing Arteriovenous Fistulas in Hemodialysis.

Puncturing an arteriovenous fistula (AVF) in chronic hemodialysis (HD) patients is a source of difficulty even for experienced dialysis nurses. The objective of this study was to compare the failure rate of AVF puncture by the usual technique (visual or by palpation) and after ultrasound location. This nonrandomized prospective single-center study was carried out at the Safi HD Hospital Center for 16 weeks in two successive phases, with the time between each phase dedicated to training nurses in locating punctures by ultrasound. We first evaluated 30 HD patients (300 HD sessions, i.e., 600 punctures) without ultrasound location, then the same patients (300 sessions, i.e., 600 punctures) using ultrasound location for all punctures. Ultrasound location carried out by a single nurse did not show a significant reduction in the rate of failure to puncture the AVF compared with the standard method (2.6% vs. 4%, P = 0.07). However, the rate of complications at the puncture site, recourse to medical advice, or mobilization of a second nurse were significantly reduced (P < 0.05). This single-center study showed no advantage of this approach for the effective cannulation of AVF in HD patients known to be not difficult to cannulate.

Direction- and Angle-Assisted Buttonhole Cannulation of Arteriovenous Fistula in Hemodialysis Patients: A Multicenter Randomized Controlled Trial

Rationale & ObjectiveArteriovenous fistula cannulation with the buttonhole technique is often preferred by patients but has been associated with an increased infection risk. Guidelines disagree on whether it should be abandoned, thus we assessed a technologically simple method to facilitate gentler arteriovenous fistula cannulation with potentially less discomfort and damage to the epithelial lining of the buttonhole tract.Study Design8-week, prospective, open-label, randomized controlled trial.Setting & ParticipantsPatients with buttonhole tracts receiving hemodialysis at 7 dialysis centers in Norway were randomized to the intervention group (43 patients, 658 cannulations) or control group (40 patients, 611 cannulations).InterventionDirection and angle of the established buttonhole tract were marked on the forearm skin in the intervention group, whereas the control group had no structured cannulation information system.OutcomesThe primary outcome was successful cannulation, defined as correct placement of both blunt needles at the first attempt without needing to change needles, perform extra perforations, or reposition the needle. The secondary outcomes were patient-reported difficulty of cannulation (verbal rating scale: 1 = very easy, 6 = impossible) and intensity of pain (numeric rating scale: 0 = no pain, 10 = unbearable pain).ResultsAfter a 2-week run-in period, successful cannulation was achieved in 73.9% and 74.8% of the patients in the intervention and control groups, respectively (relative risk [RR], 0.99; 95% CI, 0.87-1.12; P = 0.85). However, the probability of a difficult arterial cannulation (verbal rating scale, 3-6) was significantly lower in the intervention group (RR, 0.69; 95% CI, 0.55-0.85; P = 0.001). There were no improvements for venous cannulations. Furthermore, the probability of a painful cannulation (numeric rating scale, 3-10) was lower in the intervention group (RR, 0.72; 95% CI, 0.51-1.02; P = 0.06).LimitationsUnable to evaluate hard end points such as infections and thrombosis owing to the small sample size.ConclusionsMarking direction and angle of cannulation did not improve cannulation success rates; however, patients more often reported an unproblematic procedure and less pain.FundingNone.Trial RegistrationClinicalTrials.gov (NCT01536548).

Local anesthetics for the Nephrologist.

Several specialists in medicine use local anesthetics. In patients with kidney disease, these agents are used during catheter insertions for hemodialysis and peritoneal dialysis, arteriovenous fistula and graft procedures, kidney transplantation, parathyroidectomy, kidney biopsies, and dental and skin procedures. Patients on chronic hemodialysis use a topical application prior to use of needles for arteriovenous fistula cannulation before starting dialysis. They are also used to manage acute and chronic pain conditions, in regional nerve blockade and in multi-modal enhanced recovery protocols. Despite their frequent use by both physicians and patients, data on the use of local anesthetics in patients with kidney impairment are not well reported. This review will summarize the use of local anesthetics in chronic kidney disease, describe their pharmacology and the impact of lower estimated glomerular filtration rate on their pharmacokinetics, and suggest dose regulation in those with kidney dysfunction.

Pain associated with arteriovenous fistula cannulation: Still a problem

ContextPuncture-related pain during arteriovenous fistula cannulation is a crucial influential factor in the quality of life of chronic hemodialysis patients. Objectives/methodsIn this prospective single center study, we used a questionnaire to evaluate the patterns of pain of arteriovenous fistula cannulation in a group of hemodialysis patients. ResultsFrom a total of 123 eligible patients with arteriovenous fistula invited to participate, 83 (58 M/25 F) (median age 58 y.o.) returned questionnaires. Sixty-five benefitted from an analgesic intervention on cannulation, and 62 found this intervention effective. We evaluated the pain intensity with the échelle visuelle analogique score, the equivalent of Visual Analogue Scale score in French. No specific analgesic intervention (lidocaine patch or cream, vapocoolant spray) was more effective than the others (pNS). 30/65 patients with and 10/18 patients without analgesic intervention reported pain on cannulation (échelle visuelle analogique>1) (pNS). 21/65 patients with and 6/18 patients without analgesic intervention reported pain on needle retraction (pNS). Forty of the 65 patients with analgesic intervention and 11/18 patients without intervention feel stressed before each cannulation. The stress of arteriovenous fistula-related pain is significantly associated with a sensation of pain on cannulation (P=0.047) and needle retraction (P=0.002). ConclusionDespite prophylactic measures for arteriovenous fistula cannulation pain, patients frequently experience stress and unpleasant sensations associated with the procedure.

Using two-holed needles for both arterial and venous accesses to the arteriovenous fistula to improve flow during hemodialysis.

This prospective study compared methods using both arterial and venous needles with back eyes with those using only arterial needle with back eye for arteriovenous fistula cannulation. Sixty-one patients receiving hemodialysis (HD) via an arteriovenous fistula were evaluated. All patients underwent arteriovenous fistula puncture using only arterial needle with back eye in first 3 months and both arterial and venous needles with back eyes in following 3 months. Arterial and venous pressures, blood flow velocities, total blood volume cleared, and Kt/V values were compared. Mean blood flow velocity, arterial pressure, Kt/V, and cleared total blood volume values were higher and venous pressure was lower in patients who underwent cannulation using both needles with back eyes than in those with only the arterial needle with back eye. For arteriovenous fistula cannulation, using both arterial and venous needles with back eyes provides adequate HD more successfully.