S CHEN1, C.C. CHAI1, C. SI1, S.H. TAN1, H.R. RAVINDRAN1, J. TAN1, M.T.P. MARTINEZ1, Y. GAO1, Y.R. YEAP1, A.Y.L. LIU1
Khoo Teck Puat Hospital1
Cannulation of complex arteriovenous fistula (AVF) or graft (AVG) is challenging for renal nurses. Ultrasound (US) guidance on central and peripheral venous access visualisation has been widely adopted in nephrology and shown to reduce complications on vascular interventions. With broader adoption of handheld US devices in clinical services, renal nurses could acquire this point-of-care technique to increase the successful cannulation rate while facilitating confidence build-up during training and practice. We aim to evaluate the use of handheld US on difficult AVF/AVG cannulation in a hospital-based dialysis unit.
We conducted a prospective pilot study from January to June 2021. Five renal nurses were trained by an interventional nephrologist before patient recruitment and had completed a pre- and post-training questionnaire on their confidence level. Twenty-eight haemodialysis patients with complex AVF/AVG were randomised to US-guided or conventional cannulation. Data on the total time spent on cannulation and patients’ pain scores were also collected.
Renal nurses showed an increase in confidence level after training (pre-training score 26.6± 6.9 versus post-training score 36.4±3.0; p=0.014). There was a trend toward a higher success rate for US-guided (100%) versus conventional (71.4%) cannulation (p=0.059). The amount of time spent on cannulation and pain scores were comparable between the two groups.
Our pilot study showed that US-guided cannulation increased renal nurses’ confidence level on difficult cannulation and potentially improved success rate. Larger scale studies are required to further assess the applications of handheld US in AVF/AVG cannulation, particularly in different clinical settings (e.g. chronic dialysis centres).