Journal of Vascular Access最新文献

{"title":"Investigation of the effect of breathing exercise on invasive pain associated with arteriovenous fistula cannulation in hemodialysis patients: Randomized controlled, single-blind study.","authors":"Sila Caglar, Nurten Ozen","doi":"10.1177/11297298231194756","DOIUrl":"10.1177/11297298231194756","url":null,"abstract":"<p><strong>Background: </strong>Pain due to puncture during arteriovenous fistula (AVF) cannulation is a very important symptom that affects the quality of life in patients undergoing continuous hemodialysis (HD) therapy. The aim in this study is to examine the effect of breathing exercise applied for long-term on invasive pain experienced during AVF cannulation in HD patients.</p><p><strong>Methods: </strong>This randomized controlled, single-blind design study was conducted in a private dialysis center in Istanbul between November 2021 and April 2022. The patients in the intervention group were given breathing exercises before fistula cannulation during 12 HD sessions. Before the dialysis nurse performed the cannulation procedure, the patient was told by the researcher to perform breathing exercises and the exercise was completed after intervention for the cannulation. No intervention was made for the patients in the control group. Pain was assessed with the Visual Analog Scale (VAS) by a nurse who is not involved in the study. Mann-Whitney <i>U</i> Test, Chi-Square Test, Fisher's Exact Test, Friedman Test for repeated measurements were used in statistical analysis of data.</p><p><strong>Findings: </strong>The study was completed with a total of 112 patients, 59 in the intervention group and 53 in the control group. It was determined that the VAS scores of the patients in the intervention group were statistically significantly lower than the patients in the control group from the first measurement to the twelfth measurement (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>It was determined that the breathing exercise applied before the AVF cannulation reduced the invasive pain experienced during cannulation.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10435108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early experience with the Abre venous stent for central venous stenoses and occlusions in hemodialysis patients.","authors":"Shimon Aronhime, Shmuel Balan, Aleksey Timokhin, Yaniv Avital, Alexei Cherniavsky","doi":"10.1177/11297298231193893","DOIUrl":"10.1177/11297298231193893","url":null,"abstract":"<p><strong>Background: </strong>Hemodialysis patients are prone to stenoses and occlusions throughout the access circuit. Central venous stenoses or occlusions (CVO) can be particularly challenging. There are many different types of balloons and stents available for treatment, including a new generation of dedicated venous stents (VS). In this study, we report our experience and patency rates with the Abre VS in central venous lesions in hemodialysis patients.</p><p><strong>Methods: </strong>From April 2020 to May 2023, all procedures with Abre VSs placed for central venous lesions in hemodialysis patients were retrospectively analyzed from a prospectively collected database of 980 hemodialysis access interventions. Follow up outcomes were obtained from angiographic images on follow up angiography and included primary patency and primary assisted patency. Effective hemodialysis was considered a surrogate for access patency if no angiographic follow-up was available.</p><p><strong>Results: </strong>A total of 15 patients with CVO were treated with the Abre VS. Technical success was 100%. All patients were able to achieve adequate hemodialysis after VS placement. Stents were placed across the thoracic inlet in 73% of patients. Post procedure primary patency at the target lesion site was 85% at 6 months and 70% at 12 months. Primary assisted patency of the circuit was 93% at 6 and 12 months. No stent fractures were observed.</p><p><strong>Conclusion: </strong>Treatment of CVO remains extremely challenging, especially when the lesion is located at the thoracic inlet. In these patients, VSs provide acceptable primary patency rates and allow patients to continue to receive effective hemodialysis. However, routine follow-up and re-interventions will likely be necessary to maintain patency in the long term.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10124081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonographic diagnosis and evaluation in patients with superficial radial arteries.","authors":"Tetsuya Uchino, Masahiro Miura, Shigekiyo Matsumoto, Chihiro Shingu, Takaaki Kitano","doi":"10.1177/11297298231164661","DOIUrl":"10.1177/11297298231164661","url":null,"abstract":"<p><strong>Background: </strong>The superficial radial artery (SRA) is a rare congenital anomaly in the forearm. However, it can be detected incidentally via trauma, intraoperative findings, angiography, or ultrasonography. In addition, intra-arterial infusion of intravenous medications and difficulties in radial artery catheterization may occur in cases of the SRA.</p><p><strong>Methods: </strong>Between December 2016 and July 2020, anomalous branches of radial arteries were found incidentally in nine patients at the preoperative visit and identified during ultrasound-guided radial artery puncture in 21 patients when radial artery catheterization using the palpation method proved difficult. Ultrasound examinations were performed for diagnosis and evaluation of these 30 patients.</p><p><strong>Results: </strong>All anomalous branches of the radial artery were SRAs; 11 (37%), 13 (43%), 6 (20%) were present on the right side, on the left side, and bilaterally, respectively. All SRAs ran close to the cephalic vein. The vascular diameters of the radial arteries were the smallest in the radial artery distal to the SRA bifurcation (followed by in the SRA) and the largest in the radial artery proximal to the bifurcation (<i>p</i> < .001). In two cases, color Doppler study revealed that both the blood flow and color Doppler signal of the SRA disappeared with compression of the radial artery proximal to the SRA bifurcation.</p><p><strong>Conclusions: </strong>Because the SRA runs very close to the cephalic vein, a tourniquet applied to the arm may easily lead to intravenous catheter misplacement into the SRA. In addition, the small radial artery distal to the SRA bifurcation causes difficulty in radial artery catheterization. Furthermore, SRA cases may have falsely normal Allen's test results. Therefore, the authors recommend that the SRA must be identified before vascular puncture for safe vascular catheterization in the forearm.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9774623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planning vascular access creation: The promising role of the kidney failure risk equation.","authors":"Bernardo Marques da Silva, Mariana Dores, Onassis Silva, Marta Pereira, Cristina Outerelo, Alice Fortes, José António Lopes, Joana Gameiro","doi":"10.1177/11297298231186373","DOIUrl":"10.1177/11297298231186373","url":null,"abstract":"<p><strong>Background: </strong>Planning for vascular access (VA) creation is essential in pre-dialysis patients although optimal timing for VA referral and placement is debatable. Guidelines suggest referral when eGFR is 15-20 mL/min/1.73 m². This study aimed to validate the use of kidney failure risk equation (KFRE) in VA planning.</p><p><strong>Methods: </strong>Retrospective analysis of all adult patients with CKD who were referred for first VA placement, namely AVF or AVG, at a tertiary center, between January 2018 and December 2019. The four-variable KFRE was calculated. Start of KRT, mortality, and VA placement were assessed in a 2-year follow-up. We used Cox regression to predict KRT start and calculated the ROC curve.</p><p><strong>Results: </strong>256 patients were included and 64.5% were male, mean age was 70.4 ± 12.9 years and mean eGFR was 16.09 ± 10.43 mL/min/1.73 m². One hundred fifty-nine patients required KRT (62.1%) and 72 (28.1%) died in the 2-year follow-up. The KFRE accurately predicted KRT start within 2-years (38.3 ± 23.8% vs 17.6 ± 20.9%, <i>p</i> < 0.001; HR 1.05 95% CI (1.06-1.12), <i>p</i> < 0.001), with an auROC of 0.788 (<i>p</i> < 0.001, 95% CI (0.733-0.837)). The optimal KFRE cut-off was >20%, with a HR of 9.2 (95% CI (5.06-16.60), <i>p</i> < 0.001). Patients with KFRE ⩾ 20% had a significant lower mean time from VA consult to KRT initiation (10.8 ± 9.4 vs 15.6 ± 10.3 months, <i>p</i> < 0.001). On a sub-analysis of patients with an eGFR < 20 mL/min/1.73 m², a KFRE ⩾ 20% was also a significant predictor of 2-year start of KRT, with an HR of 6.61 (95% CI (3.49-12.52), <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>KFRE accurately predicted 2-year KRT start in this cohort of patients. A KFRE ⩾ 20% can help to establish higher priority patients for VA placement. The authors suggest referral for VA creation when eGFR < 20 mL/min/1.73 m² and KFRE ⩾ 20%.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9836417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and incidence of peripheral venous catheters-related phlebitis between 2017 and 2021: A multicentre study (Flebitis Zero Project).","authors":"José Antonio Cernuda Martínez, María Belén Suárez Mier, María Del Carmen Martínez Ortega, Raquel Casas Rodríguez, Carmelo Villafranca Renes, Camino Del Río Pisabarro","doi":"10.1177/11297298231189963","DOIUrl":"10.1177/11297298231189963","url":null,"abstract":"<p><strong>Background: </strong>The peripheral venous catheter is one of the most frequently used devices in inpatient units worldwide. The risk of complications arising from use of peripheral venous catheters is low, but phlebitis frequently develops.</p><p><strong>Methods: </strong>A multicentre, prospective cohort study was conducted in 65 Spanish hospitals on 10,247 inpatients who had had a total of 38,430 peripheral venous catheters inserted. Data were collected for 15 consecutive days in 2017, 2018, 2019, 2020 and 2021. Central tendency and dispersion were measured, cumulative incidence and incidence density were determined and odds ratios (OR) were also calculated using binary logistic regression.</p><p><strong>Results: </strong>The incidence density of phlebitis, during the period from 2017 to 2021, was 1.82 cases of phlebitis per 100 venous catheter-days. The difference between average cumulative incidence of phlebitis per year was statistically significant as determined by ANOVA test results (<i>F</i> = 10.51; df = 4; <i>p</i> < 0.000). Unequivocal risk factors for phlebitis were revealed to be hospitals with more than 500 beds (OR = 1.507; <i>p</i> < 0.001), patients suffering from neoplastic disease (OR = 1.234; <i>p</i> < 0.001) and the first 3-4 days after insertion (OR = 1.159; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>A correct knowledge of insertion technique and venous catheter maintenance is likely to reduce the incidence of phlebitis and other complications, and hence continuing education of nurses is essential.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9874251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-cuffed central venous catheter for unplanned and urgent start haemodialysis in chronic kidney disease: A multi-centre experience from India.","authors":"Subrahmanian Sathiavageesan, Balamurugan Swaminathan, Murugan Myvizhiselvi, Gopalakrishnan Ramakrishnan, Ramprasad Elumalai","doi":"10.1177/11297298231191369","DOIUrl":"10.1177/11297298231191369","url":null,"abstract":"<p><strong>Background: </strong>Central Venous Catheter (CVC) is indispensable to unplanned and urgent start haemodialysis in chronic kidney disease (CKD). While cuffed CVC is preferred to non-cuffed CVC for urgent start haemodialysis, patient's clinical condition might warrant immediate insertion of non-cuffed CVC. In the resource poor setting, non-cuffed CVCs might have to be retained longer than guideline recommended limit of 2 weeks. In this multi-centre retrospective observational study, the real-world survival of non-cuffed CVC was assessed among CKD patients who initiated dialysis urgently.</p><p><strong>Methods: </strong>CVC survival was assessed by Kaplan-Meier survival estimate. Predictors of premature CVC loss were assessed using multi-level multi-variate Cox frailty model wherein, each centre was provided with a random intercept to account for within-centre correlation of practice patterns.</p><p><strong>Results: </strong>Among 433 non-cuffed CVCs, there were 393 removals out of which 80% were elective and 20% were premature. The median CVC survival was 37 days (95% CI: 35-41). The rate of premature CVC removal was 4.5/1000 CVC-days (95% CI: 3.6-5.6). Mechanical complications followed by central line associated blood stream infection (CLABSI) were the most common reasons for premature removal. Rate of CLABSI was 1.7/1000 CVC-days (95% CI: 1.2-2.5). Diabetic CKD significantly increased the hazard of premature CVC removal (HR 1.91, 95% CI: 1.01-3.63, <i>p</i> = 0.04) while right internal-jugular location decreased the hazard (HR 0.22, 95% CI: 0.13-0.38, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Prolonged retention of non-cuffed CVC (median 37 days) is common in resource-poor setting. It is worrisome and calls for pre-emptive access creation.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9946831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of point of care ultrasound (POCUS) training on arteriovenous access assessment and cannula placement for haemodialysis.","authors":"Kathleen Hill, Ashleigh Jaensch, Jessie Childs, Stephen McDonald","doi":"10.1177/11297298231194100","DOIUrl":"10.1177/11297298231194100","url":null,"abstract":"<p><strong>Background: </strong>Haemodialysis requires a permanent vascular access and relies on cannulation with two large bore needles. Point Of Care Ultrasound (POCUS) is a tool that may assist nursing staff with visualising cannula placement and prevent miscannulation. This can be particularly useful in regional hospitals with limited access to vascular access specialists.</p><p><strong>Aims: </strong>To examine the impact of POCUS provision and education for nursing staff on confidence in cannulation and to understand the patient experience at three regional hospital haemodialysis units in South Australia.</p><p><strong>Methods: </strong>A POCUS machine and dedicated nursing education were provided at each of the three sites. A pre-test post-test model was used to assess the individual nurses perceived competency before and after the delivery of a series of online ultrasound education modules and face to face training. Patient reported outcome measures (PROMs) were collected to understand the use of POCUS from the client perspective.</p><p><strong>Results: </strong>There was a shift towards 'agree' or 'strongly agree' for all nursing surveys in regard to perceived competency (<i>n</i> = 15). This was statistically significant (<i>p</i> ⩽ 0.05) for all questions other than question 1 'I am confident in my ability to physically assess vascular access' (<i>p</i> = 0.06). The patients that completed the PROMs (<i>n</i> = 17) overall supported the ease and use of POCUS for haemodialysis cannulation and felt that it contributed to the nursing staff competency in cannulation.</p><p><strong>Conclusion: </strong>POCUS has the potential to be a valuable tool in regional haemodialysis units to support vascular access cannulation and potentially avoid metropolitan transfer due to cannulation difficulties. The non-significant change post intervention for question 1 likely reflects the haemodialysis nurses inherent pre-existing capacity to assess vascular access without the use of POCUS using the standard process of visual inspection, the use of a stethoscope and palpation ('look, listen and feel').</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10069371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes for femoral tunneled-cuffed hemodialysis catheters with different tip positions: A single-center retrospective study.","authors":"Sudan Wu, Lifeng Zhang, Qiqi Wang, Haijun Wei, Siwei Zheng, Dan Huang, Jie Ni, Yang Liu","doi":"10.1177/11297298231195543","DOIUrl":"10.1177/11297298231195543","url":null,"abstract":"<p><strong>Background: </strong>Tunneled-cuffed catheter (TCC) reaching the mid-atrium has been demonstrated to be associated with improved catheter survival. However, whether similar conclusions can be made for femoral TCC reaching the inferior vena cava (IVC) remains unknown.</p><p><strong>Methods: </strong>Data from 47 patients with end-stage renal disease receiving right femoral TCC were retrospectively collected and analyzed. The primary patency, catheter dysfunction, and TCC-associated infection rate were compared between patients with TCC tip at the IVC and those with TCC tip at non-IVC.</p><p><strong>Results: </strong>TCC tips were located at the IVC in 26 patients and non-IVC in 21 patients. The technical success rates for both groups were 100%. The primary patency of the former group were significantly higher than those of the latter group at 3 months (92.3% vs 61.9%, <i>p</i> = 0.011), 6 months (80.8% vs 52.4%, <i>p</i> = 0.017), and 12 months (50.0% vs 28.5%, <i>p</i> = 0.024) follow-up, respectively. Kaplan-Meier curve analysis demonstrated significantly different catheter dysfunction-free survival between the two groups (log-rank <i>p</i> = 0.017). The overall TCC-associated infection rate was similar between the two groups (7.7% vs 9.5%, <i>p</i> = 0.82).</p><p><strong>Conclusion: </strong>Femoral TCC with tips at IVC was associated with higher primary patency, lower catheter dysfunction but similar TCC-associated infection rate as compared with those at non-IVC.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10221142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of mid-thigh exit site venous catheters in multidrug resistant colonized patients.","authors":"Arianna Bartoli, Mattia Donadoni, Massimiliano Quici, Giulia Rizzi, Leyla La Cava, Antonella Foschi, Maria Calloni, Francesco Casella, Elena Martini, Alba Taino, Chiara Cogliati, Antonio Gidaro","doi":"10.1177/11297298231188150","DOIUrl":"10.1177/11297298231188150","url":null,"abstract":"<p><strong>Introduction: </strong>Venous catheters inserted in superficial femoral vein and with mid-thigh exit site have emerged as a feasible and safe technique for central or peripheral tip's venous access, especially in agitated, delirious patients. The spread of multidrug-resistant bacterial (MDR) strains is an emerging clinical problem and more and more patients are being colonized by these types of bacteria. The aim of this study is to evaluate the incidence of central line associated bloodstream infections (CLABSI) or catheter related bloodstream infections (CRBSI) in mid-thigh catheters in patients with positive rectal swabs to evaluate the safety of this procedure and the real infection risk.</p><p><strong>Methods: </strong>In this retrospective observational study, we analyzed data on patients with mid-tight catheters inserted from May 2021 to November 2022. All surveillance rectal swabs were recorded. In addition, to collect data on CLABSI and CRBSI, the results of all blood and catheter tip cultures performed during the hospital stay were acquired.</p><p><strong>Results: </strong>Six hundred two patients were enrolled, 304 patients (50.5%) had a rectal swab; 128 (42.1%) swabs were positive for MDR. Nine CLABSI (only two in patients with a positive rectal swab) and three CRBSI were detected. No statistical difference in the absolute number of CLABSI and CRBSI and in the number of infections per 1000 catheter days emerged between the overall population and patients with positive rectal swabs (respectively <i>p</i> = 0.45 and <i>p</i> = 0.53). Similarly, no statistical difference in the number of CLABSI and CRBSI was found among patients with a negative swab and patients with a positive one (respectively <i>p</i> = 0.43 and <i>p</i> = 0.51).</p><p><strong>Conclusions: </strong>According to our data, cannulation of the superficial femoral vein represents a safe location in patients with positive rectal swabs.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9831445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin pigmentation as landmark for arteriovenous fistula cannulation in hemodialysis.","authors":"Rui Pinto, Emanuel Ferreira, Clemente Sousa, João Pedro Barros, Ana Luísa Correia, Ana Rita Silva, Andreia Henriques, Fernando Mata, Anabela Salgueiro, Isabel Fernandes","doi":"10.1177/11297298231193477","DOIUrl":"10.1177/11297298231193477","url":null,"abstract":"<p><strong>Background: </strong>The cannulation of the arteriovenous fistula (AVF) for hemodialysis (HD) has traditionally depended on the nurse's tactile sensation, which has been associated with suboptimal needle placement and detrimental effects on vascular access (VA) longevity. While the introduction of ultrasound (US) has proven beneficial in mapping the AVF outflow vein and assisting in cannulation planning, aneurysmal deformations remain a common occurrence resulting from various factors, including inadequate cannulation techniques. Within this context, the utilization of skin pigmentation as a clinical landmark has emerged as a potential approach to enhance cannulation planning in HD.</p><p><strong>Methods: </strong>A prospective longitudinal study was undertaken to investigate the correlation between the occurrence of venous morphological deformations and the cannulation technique guided by skin pigmentation after a 2-month period of implementation.</p><p><strong>Results: </strong>Thirty patients were enrolled in the study with 433 cannulations being described within the first 2 months of AVF use. The overall rate of cannulation-related adverse events was 21.9%. Comparative analysis demonstrated a statistically significant relationship (<i>p</i> < 0.001) between aneurysmal deformation and non-compliance with the proposed cannulation technique, resulting in cannulation outside the designated points. Non-compliance was primarily attributed to nurse's decision (57.1%).</p><p><strong>Conclusion: </strong>The integration of US mapping of the AVF outflow vein and the utilization of skin pigmentation as a guiding tool have shown promising results in enhancing cannulation planning over time. Consistent adherence to a cannulation technique other than the area technique has been found to reduce the risk of AVF morphological deformation. These findings underscore the potential benefits of incorporating skin pigmentation as a clinical landmark in cannulation practices, highlighting its ability to impact positively cannulation outcomes.</p>","PeriodicalId":56113,"journal":{"name":"Journal of Vascular Access","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10018092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}