Considerations in Access Cannulation: Traditional and Evolving Approaches
| Autor: | Deborah Brouwer-Maier, Karthik Ramani, Lalathaksha Kumbar |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Percutaneous medicine.medical_treatment 030232 urology & nephrology Arteriovenous fistula 030204 cardiovascular system & hematology Catheterization 03 medical and health sciences Dialysis access Arteriovenous Shunt Surgical 0302 clinical medicine Aneurysm Hematoma Renal Dialysis Subsequent revision medicine Humans business.industry medicine.disease Surgery Surgery Computer-Assisted Point-of-Care Testing Nephrology Kidney Failure Chronic Hemodialysis Thickening business Vascular Access Devices |
| Zdroj: | Advances in Chronic Kidney Disease. 27:199-207 |
| ISSN: | 1548-5595 |
| Popis: | Needle cannulation of hemodialysis access is the soft underbelly of hemodialysis access care that has remained unchanged for a long time. Cannulation error results in complications such as infiltration, hematoma, subsequent revision procedures, and potential loss of hard-earned access. The "best" cannulation method is contingent upon access type and characteristics along with local expertise. The rope ladder technique of cannulation, characterized by successive rotation of puncture sites with each hemodialysis session, permits sufficient time for healing of prior cannulation sites, and reduction in complications such as bleeding, infection, and aneurysm development. A steeper needle angle, higher blood flow rates, and deep needle tip can lead to wall stress on the posterior wall and up to 10 cm from the needle cannulation site. Plastic cannulas provide a viable alternative to metallic needles; they have lower complications and a favorable cost-benefit ratio. There is lack of evidence to support an optimal arterial needle direction configuration. Needle injury may promote intimal thickening, but its effect on access outcomes is currently unknown. Percutaneous creation of arteriovenous fistula presents new challenges in dialysis access cannulation. Point-of-care ultrasound-guided cannulation will likely lead to a paradigm shift in access cannulation. Novel care delivery using cannulation stations is a promising development. |
| Databáze: | OpenAIRE |
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