Use of ultrasound in cannulation of haemodialysis vascular access and affect on needle placement and cannulation success.

The study will be undertaken over a 6 to 12 month period and will evaluate two conditions: (1) Point of care ultrasound guided cannulation and (2) usual practice of blind cannulation, when applied by different nurses. Each patient will be exposed to each condition and each one of the 10 nurses will implement each condition on the 20 haemodialysis patients.. The crossover design (across conditions and nurses) controls for differences between individuals and differences in nurses skills. Essentially each individual within the study acts as his/her own control, thus decreasing the effect of factors such as: AVF diameter, AVF depth, AVF age, condition of skin, presence of aneurysm or false aneurysm, patient comorbidities, and patient age. Point of care ultrasound is the use of a small portable ultrasound machine with a sterile probe cover, and using sterile gel. The ultrasound is used to first assess an appropriate cannualation area, then the probe is held in the non-dominant hand whilst the nurse cannulates and watches the needle progress into the vessel on the ultrasound screen. After each successful cannulation static ultrasound images will be taken by a second person (not involved in the cannulation) in both transverse and longitudinal planes. The images will be saved to a removable disc, and will be printed for third party review. A third person will be blinded to both the condition and the nurse. The will measure with a ruler the location of the needle relative to the right and left side of the vessel and the top and bottom of the vessel. Patients will attend their usual haemodialysis session and prepare for haemodialysis as normal. The ultrasound guided cannulation sessions may take a little longer than the blind cannulation sessions due to machine set up. The patients will be given a short survey after each cannulation session to measure their satisfaction with the condition they received that day. The study will also test the feasibility of conducting a controlled random order crossover trial for measurement of POC ultrasound guided cannulation versus usual practice by testing recruitment, retention, attrition, methods of data collection and will provide data on variability and effect sizes which will inform the development of a future larger multi-site trial. The researcher will be in attendance to collect data and note intervention adherence. There is no requirement for a wash out period for this study.