Arteriovenous fistula cannulation in hemodialysis: A vascular access clinical practice guidelines narrative review

Abstract

The cannulation of an arteriovenous fistula (AVF) by the hemodialysis (HD) nurse is challenging. Despite it being the focus of extensive research, it is still one of the majors causes of damage making it prone to failure. A considerable number of Clinical Practice Guidelines (CPGs) for the management of vascular access (VA) have been published worldwide over the past two decades. This review aimed to assess all information available in the selected CPG regarding AVF cannulation for HD providing a comprehensive analysis in order to interpret possible future cannulation approaches. A total of seven CPGs were described in a coding table separated in seven subthemes: Initiation of cannulation, preparation, technique, needle selection, surveillance, pain, and education. Our analysis outlines current CPGs for HD VA cannulation with lack of good evidence support for the majority of the recommendations, showing that, there is an urgent need for international collaboration and coordination to ensure relevant and high-quality evidence. Future CPGs must consider recommendations with better grading of evidence aiming patient-centered care and nurse decision models that can potentially represent better AVF cannulation outcomes.

How to choose the appropriate cannulation technique for vascular access in hemodialysis patients

“…Arteriovenous access cannulation should not be restricted to the technique, as other aspects are very important for its success. Several aspects influence the quality of access cannulation and may thus affect access survival and the quality of dialysis [15]. Identification of access flow, selection of cannulation site, selection of needles type, and preparation of cannulation site, are very important before arteriovenous access cannulation.…”

Knowledge of vascular access among hemodialysis unit nurses and its influencing factors: a cross-sectional study

“…Only with solid knowledge of vascular access can nurses provide proper nursing and instructions to HD patients and promptly identify vascular access-related complications, which will help patients to improve their capabilities in maintaining vascular access and thus prolong the patency of vascular access. Studies (12,13) have shown that the training of HD unit nurses on vascular access has a positive impact on the quality management of vascular access by improving the AVF puncture techniques, reducing vascular access complications (e.g., thrombosis and stenosis), and prolonging the patency of vascular access. Therefore, hospital managers should strengthen the training and assessment of HD unit nurses' knowledge of vascular access, especially in terms of vascular access assessments, AVF puncture techniques, and other practical skills.…”

“…Naturally, HD unit nurses with more working years are exposed to more HD patients with vascular access-related nursing problems than those with fewer working years, and also have more work experience. For example, AVF cannulation is managed with graded authorization based on working years, and the cannulation of new and difficult AVFs is mainly performed by nurses with more working years (13). Therefore, HD unit nurses have more knowledge of vascular access.…”

Influence of renin–angiotensin system blockades on vascular access survival in patients on maintenance hemodialysis

“…This may be associated with the factor that the vascular access outcome is a result of the complex interplay of several risk factors, and patients on HD have heterogeneous characteristics. Vascular access outcomes are known to be influenced by various factors, including demographic factors such as age, sex, race/ethnicity; clinical comorbidities like cardiac, pulmonary, or peripheral vascular diseases, diabetes, obesity; as well as technical factors like surgical experience, vascular access care, intervention methods, needling practices, and post-needling care [19][20][21]. Vascular access-related outcomes of patients on HD are influenced not only by simple baseline characteristics and comorbidities but also by factors such as the vascular status, vascular access location or AVG presence, the specific HD center, and the experience of the nursing staff.…”