Indicating Direction and Angle for Cannulating of AV-fistula in Hemodialysis Patients

Indicating Direction and Angle for Button-hole Cannulating of AV-fistula in Hemodialysis Patients - a Randomized Controlled Study

St. Olavs Hospital, Haukeland University Hospital, Vestre Viken Hospital Trust, Sykehuset Innlandet HF, Kristiansund Hospital, Bodø sykehus, University Hospital, Akershus

Arteriovenous fistula is the preferred access for hemodialysis, and cannulation using a "button-hole" technique is increasingly recommended. By using the same two sites for cannulation there are reports of less risk of complications and less pain for the patient. However, button-hole cannulation can be difficult for the dialysis nurse, and failing cannulations can damage the AV fistula and increase patient discomfort. The investigators therefore will test whether a simple marking on the skin of the direction and angle of cannulation used in each specific patient could improve the probability of a successful and painfree cannulation.

Standard practice; i.e. no marks on skin to help find correct direction and angle for introducing needles

A successful cannulation is defined as being able to insert a blunt needle in both canals at the first attempt.

Nurse and patients describe on a Verbal Rating Scale (1-6) how difficult the cannulation was experienced. All dialysis sessions are scored.

Patients describe on a Verbal Rating Scale (0-10) how strongly they fear the cannulation. Assessed once a week.

Patients describe on a VAS scale (0-10) how painful the cannulation was experienced. Assessed once a week.

Inclusion Criteria: chronic kidney disease hemodialysis arteriovenous fistula established buttonhole technique informed consent signed Exclusion Criteria: child minor not speaking Norwegian not willing to sign informed consent

Rønning MI, Benshop P , Hallan S. Direction and angle-assisted cannulation of AV-fistula in hemodialysis patients - a rancomized controlled study. 2016; Oral presentation for the Vascular Access Society of America, Chicago 2016, abstract 1.1.4.8

Ronning MI, Benschop WP, Ovrehus MA, Hultstrom M, Hallan SI. Direction- and Angle-Assisted Buttonhole Cannulation of Arteriovenous Fistula in Hemodialysis Patients: A Multicenter Randomized Controlled Trial. Kidney Med. 2021 Dec 1;4(2):100393. doi: 10.1016/j.xkme.2021.10.006. eCollection 2022 Feb.