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Sousa CN, Teles P, Ribeiro OMPL, Sousa R, Lira MN, Delgado E, Oliveira D, Campos L, Fernandes F, Moura SCM, Delgado MF, Sá TG, Teixeira SMP, Souza LH, Ribeiro RCHM, Oliveira GFN, Mendonça AEO, Ozen N. How to choose the appropriate cannulation technique for vascular access in hemodialysis patients. Ther Apher Dial 2023; 27:394-401. [PMID: 36717974 DOI: 10.1111/1744-9987.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.
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Affiliation(s)
- Clemente Neves Sousa
- S Francisco Dialysis Unit, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Paulo Teles
- School of Economics and LIAAD-INESC Porto LA, Porto University, Porto, Portugal
| | - Olga Maria Pimenta Lopes Ribeiro
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Rui Sousa
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal
| | | | | | | | | | | | - Sandra Cristina Mendo Moura
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Mogadouro Dialysis Unit-TECSAM; Unidade de Local Saúde Nordeste, Bragança, Portugal
| | - Millena Freire Delgado
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal
| | | | | | - Lara Helk Souza
- Medical School of São José do Rio Preto (FAMERP), São Paulo, Brazil
| | | | | | | | - Nurten Ozen
- Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
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Agarwal AK, Boubes KY, Haddad NF. Essentials of Vascular Access for Home Hemodialysis. Adv Chronic Kidney Dis 2021; 28:164-169. [PMID: 34717863 DOI: 10.1053/j.ackd.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hemodialysis (HD) at home has gained increasing popularity in recent years because of regulatory and financial issues. Creation and maintenance of a well-functioning, cannulatable vascular access is essential for performance of home HD (HHD). A vascular access team-based approach to creation, maintenance, and troubleshooting of vascular access can facilitate removing barriers to cannulation at home related to fear of pain and bleeding associated with large bore needles. Frequent cannulation of HD access is associated with more frequent access complications, especially infections. Thus, proper cannulation of arteriovenous access requires careful training of rope ladder and buttonhole techniques to avoid infectious and traumatic complications that can lead to dire consequences. Development of better methods of creating buttonholes and single needles for dialysis can facilitate HHD. A culture of self-cannulation at dialysis centers can also promote HHD.
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Singapogu R, Chowdhury A, Roy-Chaudhury P, Brouwer-Maier D. Simulator-based hemodialysis cannulation skills training: a new horizon? Clin Kidney J 2021; 14:465-470. [PMID: 33623670 PMCID: PMC7886575 DOI: 10.1093/ckj/sfaa206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022] Open
Abstract
In accordance with the recently released Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, there is a significant need for focused efforts on improving hemodialysis cannulation outcomes. Toward this, structured and meaningful training of our clinical personnel who cannulate in dialysis clinics is a priority. With the availability of advanced sensors and computing methods, simulators could be indispensable tools for standardized skills assessment and training. In this article we present ways in which sensor data could be used to quantify cannulation skill. As with many other medical specialties, implementation of simulator-based training holds the promise of much-needed improvement in end-stage kidney disease patient outcomes.
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Affiliation(s)
| | - Aniqa Chowdhury
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Prabir Roy-Chaudhury
- University of North Carolina Kidney Center, Chapel Hill, NC.; and, WG (Bill) Hefner VA Medical Center, Salisbury, NC, USA
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Ozen N, Aydin Sayilan A, Sayilan S, Mut D, Akin EB, Ecder ST. Relationship between arteriovenous fistula cannulation practices and dialysis adequacy: A prospective, multicenter study. J Ren Care 2021; 48:41-48. [PMID: 33492745 DOI: 10.1111/jorc.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Successful arteriovenous fistula cannulation ensures maximum patient benefit in the haemodialysis procedure. OBJECTIVE The aim of this study was to determine the effect of various cannulation methods used for arteriovenous fistulas on dialysis adequacy. DESIGN It is a descriptive, cross-sectional and multicenter study. PARTICIPANTS A total of 164 dialysis patients from four dialysis centers were included. MEASUREMENTS Data were collected by determining patients' characteristics and the arteriovenous fistula cannulation method used, in addition to recording the Kt/V and urea reduction ratio values to evaluate dialysis adequacy. The mean Kt/V and urea reduction ratio values over 3 months after dialysis initiation were used. This trial is registered with ClinicalTrials.gov, NCT04270292. RESULTS Cannulation with the puncture method was used in 53% of the patients; the fistula needles were inserted in the antegrade direction in 43.9% of the patients; the arterial needle was rotated after fistula needle placement in 63.4% of the patients; and the arterial and venous needles were on the same vascular line in 15.2% of the patients. Placement of the fistula needle in the antegrade direction increased the Kt/V value 0.164 times (95% confidence interval: 0.002-0.212, p = .047). CONCLUSION Antegrade placement could be a factor influencing dialysis adequacy. We suggest antegrade interventions to the fistula to maximize the patient benefit from the haemodialysis treatment.
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Affiliation(s)
- Nurten Ozen
- Department of English Nursing, Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, İstanbul, Türkiye
| | - Aylin Aydin Sayilan
- Department of Nursing, Kirklareli University School of Health Science, Kırklareli, Türkiye
| | - Samet Sayilan
- Department of Internal Medicine, Kirklareli University, Kırklareli, Türkiye
| | - Dilek Mut
- Department of Intensive Care Unit, Kirklareli State Hospital, Kırklareli, Türkiye
| | - Emin B Akin
- Department of General Surgery, Unit of Renal Transplantation, Demiroglu Bilim University, İstanbul, Türkiye
| | - Suleyman T Ecder
- Department of Internal Medicine, Division of Nephrology, Demiroglu Bilim University, İstanbul, Türkiye
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Vachharajani TJ, Wong L, Niyyar VD, Abreo KD, Mokrzycki MH. Buttonhole Cannulation of Arteriovenous Fistulas in the United States. ACTA ACUST UNITED AC 2020; 1:306-313. [DOI: 10.34067/kid.0000052020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The cannulation technique of a hemodialysis vascular access has remained controversial with differing viewpoints. The quality of dialysis, overall patient safety, and individual dialysis experience often dictate the type of cannulation technique used in clinical practice. The three commonly used techniques to access a hemodialysis vascular access are the rope ladder, area, and buttonhole. Although the buttonhole technique has been around since the mid-1970s, the dialysis community remains divided on its suitability for routine use to provide maintenance hemodialysis therapy. The proponents of this technique value the ease of cannulation with less pain and discomfort whereas the opponents highlight the increased risk of infection. The actual clinical evidence from the United States is limited and remains inconclusive. The current review provides an overview of the available experience from the United States, highlighting the correct technique of creating a buttonhole, summarizing the current evidence, and recommending a need for larger randomized controlled studies in both in-center and home hemodialysis populations.
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