Ultrasound‐Guided Cannulation of the Hemodialysis Arteriovenous Access

Abstract

Successful cannulation of the arteriovenous access for patients with end-stage kidney failure to allow catheter-free hemodialysis is associated with superior patient outcomes. With an increasing rate of arteriovenous access creation, coupled with increasing dialysis patient age, the "difficult-to-cannulate" access is becoming more commonplace. Ultrasound-guided cannulation aims to improve first-time successful cannulations and minimize cannulation-associated complications such as infiltration and hematoma formation, minimizing delays in access use and reducing catheter dependency. Ultrasound-guided cannulation has the potential to not only improve patient experience but also reduce morbidity associated with complications, dialysis catheter dependency, and subsequent healthcare costs. A smooth and complication-free dialysis initiation is also important for the longevity of technique survival and self-cannulation in home hemodialysis patients. Appropriate training of the ultrasound operator is required to ensure competent image acquisition with simultaneous needling. There are various approaches and considerations in choosing how to apply the ultrasound probe and needle the access, which are often governed by personal choice, training, and institutional patterns of practice more than a robust evidence base. Future research should focus on providing more clarity on the optimal method of utilizing ultrasound guidance in arteriovenous access cannulation, the precise indications for its use and, lastly, the benefits it confers compared to traditional blind cannulation.

Point‐of‐care ultrasound use for vascular access assessment and cannulation in hemodialysis: A scoping review

“…This study demonstrated no association between small diameter and needle position, indicating that AVFs with smaller diameters can be cannulated successfully 36 . Due to the current lack of evidence, Ward et al 5 also recommended further research into the use of POCUS assessment of AVF maturation.…”

Self‐cannulation of the vascular access in home hemodialysis: Overcoming patient‐level barriers

“…A hematoma can further complicate the ability to cannulate the access as it can change the access anatomy. In‐center dialysis units will often employ the use of ultrasound guidance to aid with the “difficult‐to‐cannulate” vascular access; this is not available to the HHD patient . Hence, it is not surprising that patients with ESKD, with their impaired physical and mental health, will experience difficulties with self‐cannulation.…”

“…Tattooing of the access has also been reported as useful measure . If the vascular access limb is edematous or the access is deep within the limb, mapping is facilitated using the ultrasound . Once the patient has a good understanding of the structure and anatomy of the AVA, the ultrasound imaging may not be necessary for subsequent cannulations.…”

“…19 If the vascular access limb is edematous or the access is deep within the limb, mapping is facilitated using the ultrasound. 11 Once the patient has a good understanding of the structure and anatomy of the AVA, the ultrasound imaging may not be necessary for subsequent cannulations. However, palpation of the access should occur often during the cannulation procedure to ensure the AVA has not shifted.…”

“…In-center dialysis units will often employ the use of ultrasound guidance to aid with the "difficult-tocannulate" vascular access; this is not available to the HHD patient. 11 Hence, it is not surprising that patients with ESKD, with their impaired physical and mental health, will experience difficulties with self-cannulation. Lack of expertise, fear of needles, fear of pain and feeling ill are real barriers to patients considering HHD and self-cannulation.…”