Dialysis Access Malfunction, Dialysis; Complications, Fistula, Graft Av, Hemodialysis Complication, Vascular Access Complication, Vascular Access Site Haematoma
Conditions
Keywords
haemodialysis, dialysis, arteriovenous fistula, arteriovenous graft, ultrasound, vascular access
Brief summary
Cannulation of complex arteriovenous fistula (AVF) or graft (AVG) is a challenge to renal nurses. Ultrasound (US) guidance on central and peripheral venous access visualisation has been widely adopted in nephrology and shown to reduce complications of vascular interventions. With broader adoption of handheld US devices in clinical services, renal nurses could acquire this point-of-care technique to increase the successful cannulation rate while facilitating confidence build-up during training and practice. We aim to evaluate the use of handheld US on difficult AVF/AVG cannulation in a hospital-based dialysis unit.
Detailed description
We conducted a prospective randomised controlled study from January 2021 to January 2022. Ten renal nurses were trained by an interventional nephrologist before patient recruitment and had completed a pre- and post-training questionnaire on their confidence level. Fifty haemodialysis patients with complex AVF were randomised to US-guided or conventional cannulation. The total time spent on cannulation and patients' pain scores were also collected.
Interventions
DEVICEHandheld US device
Handheld US-guided AVF/AVG cannulation
Sponsors
National Healthcare Group, Singapore
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomised controlled trial
Eligibility
Sex/Gender
ALL
Age
21 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
1\. First-time cannulation, 2. Post-angioplasty or thrombectomy, 3. Partial stenosis confirmed with imaging or by vascular surgeons/interventional radiologists, 4. Failed cannulation by dialysis nurses at community centres, 5. Bruises or haematoma around AVF/AVG, 6. Presence of clots in AVF/AVG and 7. Deep-seated access by physical examination.
Exclusion criteria
complex access with a high risk of complications (calibre ≤0.4cm or vessels ≥0.8cm in depth from skin)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| percentage of successful cannulation | from skin contact to actual start of dialysis |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| pre-cannulation assessment time | from patient physical contact to the time before needling thru skin | time taken to assess the AVF/AVG with either US or clinical examination before cannulation |
| cannulation time | skin contact by needle to succesful aspiration of blood from needle | — |
| patients' pain score | needle to skin to end of dialysis session | 10cm visual analogue scale |
| complications | from skin contact to actual start of dialysis | need for a temporary central venous catheter, single-needle dialysis, or infiltration (e.g. haematoma) that hastened the use of AVF/AVG for the same dialysis session |
Countries
Singapore
Outcome results
None listed