Cannulation practice patterns in haemodialysis vascular access: predictors for unsuccessful cannulation.
BACKGROUND
Little is known about the relationship of cannulation practices in dialysis facilities with the frequency of failed cannulations, complications and subsequent vascular access (VA) failure.


METHODS
In an observational study the incidence of mis-cannulations and related complications were observed. Patient characteristics, comorbidities and VA characteristics like type of VA were correlated with occurrence of cannulation-related complications. In addition, the cannulation technique and practice patterns like needle direction, tourniquet use and years of experience of dialysis nurses were registered.


RESULTS
During the study period, 37% of patients with autogenous arteriovenous fistulae (AVF), and 19% of patients with arteriovenous grafts (AVG) had more than 10 miscannulations. Cannulation-induced haematoma resulted into single-needle (SN) and catheter dialysis in 40% of the patients. The use of central venous catheters (CVC) and SN dialysis were significant predictors of VA failure (p <0.0001).


CONCLUSIONS
This study demonstrated a high incidence of unsuccessful cannulation procedures and cannulation-related complications necessitating catheter and SN dialysis. The type and location of the VA is significantly related to occurrence of unsuccessful and complicated cannulation.
Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands. magdavanloon@home.nl
Magda M
MM
van Loon
Alphons G H
AG
Kessels
Alphons G H
AG
Kessel
Frank M
FM
van der Sande
Jan H M
JH
Tordoir
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000451:nursing; D002408:Catheters, Indwelling; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis / Q000451:nursing; D012307:Risk Factors