Effect of the arterial needle bevel position on puncture pain and postremoval bleeding time in hemodialysis patients: A self‐controlled, single‐blind study

Abstract

This study aimed to investigate the effect of the bevel orientation (facing upwards or downwards towards the skin) of the needle inserted into the arterial limb of the arteriovenous fistula (AVF) on puncture pain and postremoval bleeding time.Methods: This study, using a single-blind crossover design, was conducted on 35 maintenance hemodialysis patients who had been dialyzed for at least 6 months and in whom blood access was via an AVF. AVF cannulation was performed with the needle bevel pointing upward in the first six sessions and the needle bevel pointing downwards (towards the skin) in the subsequent six sessions. Needles were always inserted in the direction of blood flow. At each dialysis session, cannulation pain was measured using a visual analog scale (VAS), and the bleeding time at the end of dialysis after needle removal was recorded. Findings:The VAS score and postremoval bleeding time were lower when the needle bevel pointed downwards towards the skin during insertion (P < 0.05).Discussion: Insertion of the needle with the bevel pointed downward decreased puncture pain during cannulation and bleeding time postdialysis on needle removal.

Effect of needle orientation during arteriovenous access puncture on needed compression time after hemodialysis: A randomized controlled trial

“…Montero et al found that puncture‐related pain was less when the needle bevel was oriented downward during insertion; however, they were unable to correlate puncture pain with incision size. Ozen et al, in their study of 35 patients, reported a significant reduction in pain during access puncture using the downward bevel technique 5 . In our study, needle orientation was not associated with puncture‐associated pain.…”

“…Ozen et al, in their study of 35 patients, reported a significant reduction in pain during access puncture using the downward bevel technique. 5 In our study, needle orientation was not associated with puncture-associated pain. The pain reported by our patients on access puncture was quite mild, averaging only 1 on a 0-10 intensity scale.…”

“…4 Ozen et al, studying 35 patients over six sessions with bevel-up puncture and six with bevel down, found a reduction in postdialysis compression time after needle removal when a downward bevel technique was used for fistula puncture. 5 Montero and colleagues, in a study of 48 patients, compared the size of the skin incision with a needle bevel-down insertion approach versus a needle bevel-up technique. They reported that the size of the skin incision was smaller with the needle bevel don method.…”

“…For example, a 6‐month study of 17 patients with 374 bevel‐up and 374 bevel‐down punctures by Gaspar and colleagues showed that orienting the needle bevel downward during fistula insertion was associated with reduced blood loss during the session and significantly reduced the occurrence of hemorrhage on needle removal 4 . Ozen et al, studying 35 patients over six sessions with bevel‐up puncture and six with bevel down, found a reduction in postdialysis compression time after needle removal when a downward bevel technique was used for fistula puncture 5 . Montero and colleagues, in a study of 48 patients, compared the size of the skin incision with a needle bevel‐down insertion approach versus a needle bevel‐up technique.…”

Non-surgical interventions to control bleeding from arteriovenous fistulas and grafts inside and outside the hemodialysis unit: a scoping review

“…Hemodialysis patients with an arteriovenous fistula (AVF) or arteriovenous graft (AVG) are at increased risk of bleeding due to the coagulopathy of end-stage kidney disease [ 1 ] and the use of systemic anticoagulation in the hemodialysis circuit [ 2 ]. The risk of prolonged bleeding specifically after needle removal from AVF or AVG cannulation sites is also impacted by needle position [ 2 , 3 ] cannulation technique (buttonhole versus rope-ladder) [ 4 ], vascular access integrity, namely whether there is associated pseudoaneurysm/aneurysm, stenosis or infection [ 5 ]. Prolonged post-cannulation bleeding is associated with poor outcomes including increased rates of anemia [ 6 ], quality of life disruptions [ 7 ], and fatal catastrophic hemorrhage [ 8 , 9 ].…”