Boston—The optimal vascular access for hemodialysis patients is a permanent arteriovenous fistula (AVF) or graft (AVG), providing the lowest risk for infections related to access. Cannulation of a vascular access can be a challenge, and a common complication of new AVFs or AVGs is infiltration of the access. Infiltration of the vascular access is associated with missed hemodialysis treatments, the need for urgent surgical procedures, and loss of access.
Clinicans at Fresenius Medical Care North America developed a pilot program to determine the value in utilizing ultrasound to guide cannulation using a handheld ultrasound device. Results of the quality improvement pilot program were reported by Sheetal Chaudhuri during a poster session at the NKF Spring Clinical Meetings in a poster titled Impacts of Ultrasound Guided Access Cannulations in Hemodialysis Patients.
The initiative was conducted at 14 clinics from April 2018 through June 2018; it was divided into two phases. Phase 1 consisted of data recording on standard-of-care cannulation success and infiltration rates prior to use of an ultrasound. Phase 2 included a 4-week period using an ultrasound to guide cannulations of the AVF/AVG and collect consistent data. Documentation of cannulation success and complications was achieved using an access grading tool portal. At the end of phase 2, the researchers compared rates of successful cannulations and infiltration complications between the two phases.
The analysis included data from 310 patients: 162 in phase 1 and 148 in phase. During the pilot program, there were 690 cannulations performed in phase 1 and 471 in phase 2. Compared with phase 1 (no ultrasound), the need for a second cannulation attempt was reduced by 31.90% in phase 2 (with ultrasound device). Rates of infiltration were 69.2% lower in phase 2 versus phase 1.
“This analysis identifies that use of a handheld ultrasound for cannulation of AVFs/AVGs may improve success rates and decrease infiltrations. Further testing is needed in a larger number of patients to confirm these findings,” the researchers said.
Source: Chaudhuri S, Willetts J, Stueber I-D, et al. Impacts of ultrasound guided access cannulations in hemodialysis patients. Abstract of a poster presented at the National Kidney Foundation 2019 Spring Clinical Meetings, May 8-12, 2019, Boston, Massachusetts.