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Observational Study
. 2020 Mar;42(1):38-46.
doi: 10.1590/2175-8239-JBN-2019-0031. Epub 2019 Dec 9.

Vascular access cannulation in hemodialysis patients: technical approach

[Article in Portuguese, English]
Manuel Carlos Martins Castro  1 , Francisca Tokiko Yanagida Carlquist  1 , Celina de Fátima Silva  1 , Magdaleni Xagoraris  1 , Jerônimo Ruiz Centeno  1 , José Adilson Camargo de Souza  1
Affiliations
Observational Study

Vascular access cannulation in hemodialysis patients: technical approach

[Article in Portuguese, English]
Manuel Carlos Martins Castro et al. J Bras Nefrol. 2020 Mar.

Abstract
in English, Portuguese

Introduction: The vascular access cannulation technique varies among clinics, and guidelines on vascular access give little importance to cannulation techniques. The objective of this study was to evaluate the cannulation technique and to determine which factors are associated with each detail of the technique.

Material and methods: The vascular access cannulation was evaluated in 260 patients undergoing hemodialysis. The type and anatomical location of the vascular access, the cannulation technique, direction, gauge, and distance between needles, besides bevel direction and needle rotation were registered.

Results: The arteriovenous fistula was the most frequent vascular access (88%), the most used cannulation technique was area (100%), the needle direction was anterograde in most cases (79.5%), and the mean distance between the tips of needles was 7.57±4.43 cm. For arteriovenous grafts, the proximal anatomical location (brachial artery) and cannulation with 16G needles in anterograde position were more predominant. For arteriovenous fistulas, the distal anatomical location (radial artery) and cannulation through 15G needles were more common. Cannulation of vascular access in retrograde direction was associated with a greater distance between needles (13.2 ± 4.4 vs 6.1 ± 3 cm, p < 0.001). Kt/V was higher when the distance between needles was higher than 5 cm (1.61 ± 0.3 vs. 1.47 ± 0.28, p < 0.01).

Conclusions: The vascular access cannulation technique depends on the vascular access characteristics and expertise of cannulators. Clinical trials are required for the formulation of guidelines for vascular access cannulation.

Introdução:: A técnica de canulação do acesso vascular varia entre instituições de saúde, e as diretrizes sobre o acesso vascular dão pouca importância às técnicas de canulação. O objetivo deste estudo foi avaliar a técnica de canulação e determinar quais fatores estão associados a cada detalhe da técnica.

Material e métodos:: A canulação do acesso vascular foi avaliada em 260 pacientes em hemodiálise. Foram registrados o tipo e localização anatômica do acesso vascular, a técnica de canulação, a direção, a bitola e a distância entre as agulhas, além da direção do bisel e da rotação da agulha.

Resultados:: A fístula arteriovenosa foi o acesso vascular mais frequente (88%), a técnica de canulação mais utilizada foi a área (100%), a direção da agulha foi anterógrada na maioria dos casos (79,5%) e a distância média entre as pontas das agulhas foi de 7,57 ± 4,43 cm. Para enxertos arteriovenosos, a localização anatômica proximal (artéria braquial) e a canulação com agulhas 16G em posição anterógrada foram mais predominantes. Para as fístulas arteriovenosas, a localização anatômica distal (artéria radial) e a canulação através de agulhas 15G foram mais comuns. A canulação do acesso vascular na direção retrógrada foi associada a uma maior distância entre as agulhas (13,2 ± 4,4 v.s. 6,1 ± 3 cm, p < 0,001). O Kt / V foi maior quando a distância entre as agulhas foi superior a 5 cm (1,61 ± 0,3 vs. 1,47 ± 0,28, p < 0,01).

Conclusões:: A técnica de canulação do acesso vascular depende das características do acesso vascular e da experiência dos “canuladores”. Ensaios clínicos são necessários para a formulação de diretrizes para a canulação do acesso vascular.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest related to the publication of this manuscript.

Figures

Figure 1
Figure 1. Recommendations for cannulation of arteriovenous fistula and arteriovenous graft in hemodialysis.
See this image and copyright information in PMC

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