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. 2014 Oct;86(4):790-7.
doi: 10.1038/ki.2014.96. Epub 2014 Apr 9.

Cannulation technique influences arteriovenous fistula and graft survival

Maria Teresa Parisotto  1 , Volker U Schoder  2 , Cristina Miriunis  1 , Aileen H Grassmann  3 , Laura P Scatizzi  3 , Peter Kaufmann  1 , Andrea Stopper  1 , Daniele Marcelli  3
Affiliations
Free PMC article

Cannulation technique influences arteriovenous fistula and graft survival

Maria Teresa Parisotto et al. Kidney Int. 2014 Oct.
Free PMC article

Abstract

Hemodialysis patient survival is dependent on the availability of a reliable vascular access. In clinical practice, procedures for vascular access cannulation vary from clinic to clinic. We investigated the impact of cannulation technique on arteriovenous fistula and graft survival. Based on an April 2009 cross-sectional survey of vascular access cannulation practices in 171 dialysis units, a cohort of patients with corresponding vascular access survival information was selected for follow-up ending March 2012. Of the 10,807 patients enrolled in the original survey, access survival data were available for 7058 patients from nine countries. Of these, 90.6% had an arteriovenous fistula and 9.4% arteriovenous graft. Access needling was by area technique for 65.8%, rope-ladder for 28.2%, and buttonhole for 6%. The most common direction of puncture was antegrade with bevel up (43.1%). A Cox regression model was applied, adjusted for within-country effects, and defining as events the need for creation of a new vascular access. Area cannulation was associated with a significantly higher risk of access failure than rope-ladder or buttonhole. Retrograde direction of the arterial needle with bevel down was also associated with an increased failure risk. Patient application of pressure during cannulation appeared more favorable for vascular access longevity than not applying pressure or using a tourniquet. The higher risk of failure associated with venous pressures under 100 or over 150 mm Hg should open a discussion on limits currently considered acceptable.

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Figures

Figure 1
Figure 1
Bevel of a needle in the ‘up' position, that is, the slanted part of the needle tip faces upward upon puncture of the access. Picture with the courtesy of Bionic Medizintechnik GmbH, Friedrichsdorf, Germany.
Figure 2
Figure 2
Retrograde and antegrade positioning of arterial and venous access needles.        .
Figure 3
Figure 3
Distribution of prescribed needle size with blood flows and venous pressure levels.        .
Figure 4
Figure 4
Kaplan-Meier curves of vascular access survival according to blood flow levels, needle size, venous pressure, and cannulation technique.        .
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