A randomized controlled study of early versus standard cannulation of arteriovenous grafts in hemodialysis patients

Tawfik, Ahmed; Zidan, Mohammed H.; Salem, Amira; Salem, Amr

doi:10.1016/j.jvs.2021.08.106

Cited by 15 publications

(12 citation statements)

References 25 publications

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“…A variety of commercially available "early-cannulation grafts" (eAVGs) that use different layering materials beyond the standard polytetrafluoroethylene are now available that can be used within 24 to 72 hours after implantation and are particularly useful for patients who urgently need to start dialysis, enabling CVC avoidance. 16,17 A study that randomized 236 patients to standard AVG and 241 to eAVG reported the median time to cannulation was 19.0 days (range, 15.0-22.0 days) for standard AVG vs 3.0 days (range, 1.0-9.0 days) for eAVG (P < .001). 17 Patency rates at 12 months were similar (67.8% in standard AVG and 69.7% in eAVGs; P = .65).…”

Section: What Are the Benefits Of Avf?mentioning

confidence: 99%

“…16,17 A study that randomized 236 patients to standard AVG and 241 to eAVG reported the median time to cannulation was 19.0 days (range, 15.0-22.0 days) for standard AVG vs 3.0 days (range, 1.0-9.0 days) for eAVG (P < .001). 17 Patency rates at 12 months were similar (67.8% in standard AVG and 69.7% in eAVGs; P = .65). Early-cannulation graft use has also been reported to result in lower CVC use.…”

Section: What Are the Benefits Of Avf?mentioning

confidence: 99%

“…In this study, culture-proven bacteremia developed in 10% of patients with eAVG vs 19% with CVC within 12 months (risk ratio, 0.55; 95% CI, 0.24-0.77; P < .001). 18 Two RCTs 17,18 and 2 systematic reviews 19,20 demonstrated that earlycannulation AVGs (available for use at <3 days after placement) were safe and had comparable longer-term patency rates compared with standard AVGs. 21 An AVF requires maturation for approximately 4 months after creation before it can be used.…”

Section: What Are the Benefits Of Avf?mentioning

confidence: 99%

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Arteriovenous Access for Hemodialysis

Lok,

Huber,

Orchanian-Cheff

et al. 2024

JAMA

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ImportanceHemodialysis requires reliable vascular access to the patient’s blood circulation, such as an arteriovenous access in the form of an autogenous arteriovenous fistula or nonautogenous arteriovenous graft. This Review addresses key issues associated with the construction and maintenance of hemodialysis arteriovenous access.ObservationsAll patients with kidney failure should have an individualized strategy (known as Patient Life-Plan, Access Needs, or PLAN) for kidney replacement therapy and dialysis access, including contingency plans for access failure. Patients should be referred for hemodialysis access when their estimated glomerular filtration rate progressively decreases to 15 to 20 mL/min, or when their peritoneal dialysis, kidney transplant, or current vascular access is failing. Patients with chronic kidney disease should limit or avoid vascular procedures that may complicate future arteriovenous access, such as antecubital venipuncture or peripheral insertion of central catheters. Autogenous arteriovenous fistulas require 3 to 6 months to mature, whereas standard arteriovenous grafts can be used 2 to 4 weeks after being established, and “early-cannulation” grafts can be used within 24 to 72 hours of creation. The prime pathologic lesion of flow-related complications of arteriovenous access is intimal hyperplasia within the arteriovenous access that can lead to stenosis, maturation failure (33%-62% at 6 months), or poor patency (60%-63% at 2 years) and suboptimal dialysis. Nonflow complications such as access-related hand ischemia (“steal syndrome”; 1%-8% of patients) and arteriovenous access infection require timely identification and treatment. An arteriovenous access at high risk of hemorrhaging is a surgical emergency.Conclusions and RelevanceThe selection, creation, and maintenance of arteriovenous access for hemodialysis vascular access is critical for patients with kidney failure. Generalist clinicians play an important role in protecting current and future arteriovenous access; identifying arteriovenous access complications such as infection, steal syndrome, and high-output cardiac failure; and making timely referrals to facilitate arteriovenous access creation and treatment of arteriovenous access complications.

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Section: What Are the Benefits Of Avf?mentioning

confidence: 99%

Section: What Are the Benefits Of Avf?mentioning

confidence: 99%

Section: What Are the Benefits Of Avf?mentioning

confidence: 99%

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Arteriovenous Access for Hemodialysis

Lok,

Huber,

Orchanian-Cheff

et al. 2024

JAMA

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“…AVGs can be cannulated in 1 day to 3 weeks. 3,4 Traditionally, after maturation, cannulation of new AVF/AVG was performed by trained renal nurses through physical examination, namely listening to bruits and feeling for thrills to guide needle placement. However, physical examination is not reliable for first and difficult access cannulation (e.g., small or partial stenosis, deep-seated AVF/AVG, presence of clots, after multiple failed attempts with haematoma /swelling, and/or immature access with small vessel caliber), rendered higher rate of cannulation failure and lower AVF and AVG survival.…”

Section: Introductionmentioning

confidence: 99%

“…AVF is the best access for dialysis but requires 6 to 8 weeks to maturate. AVGs can be cannulated in 1 day to 3 weeks 3,4 …”

Section: Introductionmentioning

confidence: 99%

Handheld ultrasound‐guided cannulation of difficult hemodialysis arteriovenous access: A randomized controlled trial

Chen

Liu

Chai

et al. 2022

Hemodialysis International

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Introduction: Cannulation of complex arteriovenous fistula (AVF) or graft (AVG) frequently poses challenges to renal nursing practice. Ultrasound (US) guidance on visualizing central and peripheral venous access has been widely adopted in nephrology, reducing vascular intervention complications. Renal nurses could acquire this point-of-care technique to increase the successful cannulation rate while facilitating confidence build-up during practice. We aim to evaluate the use of handheld US on difficult AVF/AVG cannulation in a hospital-based dialysis unit. Methods:We conducted a single-center randomized controlled trial from January 2021 to January 2022. Ten renal nurses were trained by an interventional nephrologist before patient recruitment and had completed a pre-and posttraining questionnaire on their confidence level. Fifty hemodialysis patients with complex AVF were randomized to US-guided or conventional cannulation. The total time spent on cannulation and patients' pain scores were also collected.Findings: Renal nurses increased their confidence level after training (pretraining score 26.6 AE 6.9 vs. posttraining score 36.4 AE 3.0; p = 0.014). There was a higher success rate (only one cannulation attempt required) for US-guided (96%) versus conventional (72.0%) cannulation (p = 0.049). US-guided cannulation had a lower pain score than the conventional method (1.48 AE 0.73 vs. 2.13 AE 0.95, p = 0.012). The pre-cannulation assessment time and time spent on cannulation were comparable between the two groups. Discussion: Our study showed that US-guided cannulation increased renal nurses' confidence level in difficult cannulation and improved success rate. Larger scale studies are required to further assess the applications of handheld US in AVF cannulation, particularly in different clinical settings (e.g., chronic dialysis centers).

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Vascular Access Management and Care: Arterio-Venous Grafts (AVG)

Zoi,

Iglesias

2024

Principles of Specialty Nursing

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A randomized controlled study of early versus standard cannulation of arteriovenous grafts in hemodialysis patients

Cited by 15 publications

References 25 publications

Arteriovenous Access for Hemodialysis

Arteriovenous Access for Hemodialysis

Handheld ultrasound‐guided cannulation of difficult hemodialysis arteriovenous access: A randomized controlled trial

Vascular Access Management and Care: Arterio-Venous Grafts (AVG)

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