Cannulation technique influences arteriovenous fistula and graft survival

Cannulation technique influences arteriovenous fistula and graft survival

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 Apri...

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Bibliographic Details
Published in:Kidney international Vol. 86; no. 4; p. 790
Main Authors: Parisotto, Maria Teresa, Schoder, Volker U, Miriunis, Cristina, Grassmann, Aileen H, Scatizzi, Laura P, Kaufmann, Peter, Stopper, Andrea, Marcelli, Daniele
Format: Journal Article
Language:English
Published: United States 01-10-2014
Subjects:
Aged
Arteriovenous Shunt, Surgical - statistics & numerical data
Blood Pressure
Catheterization - instrumentation
Catheterization - methods
Cross-Sectional Studies
Europe
Female
Forearm - blood supply
Graft Survival
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Needles
Proportional Hazards Models
Regional Blood Flow
Renal Dialysis
Renal Insufficiency, Chronic - therapy
Time Factors
Vascular Grafting
Europe
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Summary: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.
ISSN:1523-1755
DOI:10.1038/ki.2014.96