Efficacy and Safety of Plastic Cannulae Compared with Metal Needles in the Initial Use of an Arteriovenous Fistulae in Incident Hemodialysis Patients: A Randomized Controlled Study

Abstract

<b><i>Introduction:</i></b> Successful cannulation of an arteriovenous fistula (AVF) is important in patients starting hemodialysis (HD). Metal needles have been used for decades, but the usefulness of plastic cannulae has recently been demonstrated as a new technique. <b><i>Methods:</i></b> This was a prospective, randomized, open-label study of incident HD patients. Eligible patients were randomized into 2 groups in a 1:1 ratio (<i>n</i> = 45/group). Maturation of the AVF was confirmed using Doppler ultrasound prior to first needling, and 2 well-trained nurses implemented the AVF cannulation. The primary endpoint was the initial cannulation failure rate, defined as the failure of successful completion of 3 consecutive dialysis sessions. The secondary endpoints were time for hemostasis at the end of HD, degree of patients’ pain, degree of cannulation difficulty felt by the nursing staffs, and achieving optimal HD adequacy. <b><i>Results:</i></b> The mean elapsed time from AVF creation to the first cannulation was 48.1 ± 16.7 days. A total of 17 cases of cannulation failure occurred, and the failure risk tended to be higher in the metal needle group than the plastic cannula group (hazard ratio 2.6, 95% confidence interval 0.95–7.41) after adjusting for age, gender, comorbidities, and AVF location. The overall incidence of vessel injury was higher and time for hemostasis was significantly longer in the metal group than the plastic group. The use of plastic cannula was associated with a better HD adequacy compared to a metal needle. However, the patients’ pain score (<i>p</i> = 0.004) and nursing staff’s cannulation difficulty score (<i>p</i> = 0.084) were higher in the plastic group, emphasizing the great importance of practice using plastic cannulae. <b><i>Conclusion:</i></b> The vascular outcomes of plastic cannulae were much favorable compared to metal needles in incident HD patients. The use of plastic cannulae could be a new and innovative way to improve the quality of dialysis.

The use of haemodialysis plastic cannula in prevalent patients with kidney failure: A feasibility crossover randomised trial study

“…Previous randomised controlled studies have successfully shown that plastic cannula can improve cannulation outcomes (Choi et al, 2021;Marticorena et al, 2018). In these studies, the authors recruited a targeted number of nurses with advanced levels of competency to undertake all cannulations, with one also using the adjunct of point-of-care ultrasound guided cannulation with all events (Marticorena et al, 2018).…”

“…The nurses' survey responses indicated that they would like to have a preference to use either device, based on individual patients' circumstances. Whilst the outcomes of previous studies on the use of plastic cannulae in cannulation of AVF is promising in relation to the reduction of; interventional procedures (Marticorena et al, 2018), miscannulations (Choi et al, 2021) and aborted haemodialysis sessions, there still remains a lack of empirical evidence on the topic.…”

“…Results of Marticorena et al (2018)'s randomized pilot study showed that there was 2.3 times less trauma associated infiltration with plastic cannulae compared with metal needles. Results from these studies and other reports suggest that plastic cannulae are indicated for patients who move their arm consistently during haemodialysis, those with shorter available AVF cannulation length, tortuous or shallow AVF, those who require early cannulation, known plastic allergies to metal, puncture of accesses with acute complications and to reduce nurse needlerelated injuries (Smith, V. & Schoch, M., 2017;Choi et al, 2021;Letachowicz et al, 2015;Marticorena et al, 2018;Nalesso et al, 2018;Shi et al, 2020).…”

“…Recent cohort studies and randomized controlled trials demonstrate the advantages of using plastic cannulae are decreased swelling and haematoma (Choi et al, 2021; Marticorena et al, 2018), shorter time frames to first cannulation (Shi et al, 2020) and fewer mid‐dialysis extravasations (Smith, V. & Schoch, M., 2016, 2017). Letachowicz et al (2015) reported in their retrospective cohort study that using plastic cannula on new AVF can also result in a higher primary functional patency at 1 month.…”

“…Given that new AVF are often the accesses that are problematic, many studies investigating plastic dialysis cannulae, have focused the incident haemodialysis population (Smith, V. & Schoch, M., 2017; Choi et al, 2021; Letachowicz et al, 2015; Shi et al, 2020), with few reporting on their use in the prevalent patient population (Marticorena et al, 2018). Thus, the objective of this study was to determine the feasibility of plastic cannulae in prevalent haemodialysis patients.…”