title: Impact of single-needle therapy in new chronic hemodialysis starts for individuals with arteriovenous fistulae.
abstract: The native arteriovenous fistula (AVF) is the "gold standard" for hemodialysis (HD) vascular access. Unfortunately, AVFs can develop complications including inadequate maturation, cannulation difficulties and needle infiltration. In an effort to increase successful cannulations, decrease complications and subsequent central venous catheter (CVC) use, our centre introduced single-needle (SN) dialysis in April 2006 for new chronic patients receiving their first six HD treatments. The purpose of this study was to evaluate the impact of implementing SN dialysis on the incidence of CVC placements, investigative procedures required (e.g., arteriography), and missed HD treatments within the first three months of commencing dialysis. A secondary objective was to compare these data with double-needle (DN) dialysis treatments from the previous year. Retrospective chart reviews were conducted for all new chronic HD outpatient starts from April 2005 to 2006 for patients using DN dialysis and from April 2006 to November 2007 for those using SN. Information gathered included demographic data, location and vintage of the AVF, laboratory parameters, frequency of CVC placements, arteriography, and missed HD treatments due to cannulation difficulties. In total, data pertaining to 11 DN and 22 SN patients were collected. Of the 11 DN patients, 2 (18.2%) required a CVC placement in the first three months of treatment as compared to 2 (9.1%) using SN dialysis. Similarly, arteriographic investigations of the AVF were required in 4 (36.4%) DN versus 3 (13.6%) SN patients. There were a total of 19 missed treatments (8 DN; 11 SN). Dialysis blood work results were within safe and acceptable levels for those receiving SN dialysis. Use of SN dialysis for the first six HD treatments resulted in fewer mean CVC placements and investigations while main-raining adequate laboratory parameters. These results lend support for further research in this area.
authors.affiliation: Adam Linton Dialysis Unit, London Health Sciences Centre (LHSC), London, ON. barb.wilson@lhsc.on.ca
authors.forename: Barbara
authors.initials: B
authors.lastname: Wilson
authors.forename: Lori
authors.initials: L
authors.lastname: Harwood
authors.forename: Bonita
authors.initials: B
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000706:statistics & numerical data; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation* / Q000451:nursing; D015400:Clinical Nursing Research; D015897:Comorbidity; D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D006435:Renal Dialysis / Q000295:instrumentation* / Q000451:nursing; D012189:Retrospective Studies; D016896:Treatment Outcome