Vascular access cannulation and haemostasis: a national observational study of French practices

Abstract

Background We report the results of an observational study of arteriovenous fistula (AVF) cannulation and haemostasis practices in France. Methods The study (sponsored by Brothier Pharmaceutical Inc.) was conducted in 150 dialysis units. Data obtained from 150 supervisory nurses, 1538 nurses and 3588 patients with an AVF were analysed. Results The nurses reported using rope-ladder, area or buttonhole cannulation techniques in 68, 26 and 6% of cases, respectively. Metal needles were used most frequently (64%), with mainly a diameter of 15 G or 16 G. The needle was introduced with the bevel up in 56% of cases. Compression applied using dressings (in particular, pure calcium alginate dressings) was the method of choice for haemostasis of the puncture sites and was assessed as being strong by most of the nurses and very strong in cases of prolonged bleeding. Most (82%) of the patients reported the use of local anaesthetic before cannulation and 23% reported an allergic skin reaction to the anaesthetic. Bleeding of the puncture sites lasted for >10 min for 48% of the patients and it reappeared between two sessions for 29% of the patients. Whereas the nurses appeared to have a good understanding of AVF, more than half of the patients did not know how to care for it, with 55% requiring more information. Conclusions This study underlines the lack of national consensus concerning AVF cannulation practices. It suggests that haemostasis methods of the puncture sites can be improved and it highlights the need to improve patient knowledge.

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

“…One study [ 24 ] evaluated practices of hemodialysis nurses in France in responding to post-cannulation bleeding for over 3000 patients. Nurses reported using at least 10 different dressing types, and mechanical compression devices (bracelets, clips or tourniquets) were commonly used for both short and long bleeding times (12.7% and 13.2%, respectively).…”

Effect of needle bevel position in arteriovenous fistula cannulation and bleeding during hemodialysis

“…In a study by Sallee et al, it was reported that 56% of the patients had AVF BU needle punctures and 48% of the patients had bled at the puncture sites for more than 10 minutes, however, the relationship between bleeding time and needle bevel position was not discussed [21]. In the previously mentioned study by Gaspar et al, 17 patients were recruited, and it was reported that bleeding was detected in only 27 (3.6%) punctures after a total of 748 punctures.…”

Direction- and Angle-Assisted Buttonhole Cannulation of Arteriovenous Fistula in Hemodialysis Patients: A Multicenter Randomized Controlled Trial

“…US guidelines advise against buttonhole (constant site) cannulation owing to reports of increased risk of S aureus infections. 7 However, the technique is still preferred by many patients, 24 , 25 , 26 and the European and British guidelines rather focus on the advice to reduce the infection problem because the data on infectious risk have varied greatly. 6 , 27 We, therefore, studied how to further improve the technique as this could reduce patient discomfort and potentially also reduce the infection risk.…”