Dialysis Access

Cannulation Guidance

 

Cannulation

Hemodialysis cannulation is the process of inserting two needles into a patient’s vascular access, such as an arteriovenous fistula, to allow blood to be circulated to and from the dialysis machine. The goal is to achieve successful cannulation in one attempt with minimal pain. This is crucial for the effectiveness and longevity of the access and treatment, as well as the patient’s health and wellbeing.

Challenges With Current Standard of Care for Cannulation

51% of new fistulas experience miscannulation within the first 3 dialysis sessions

22% of patients have a cannulation complication resulting in 11 days of catheter use within the first 6 months

5.2% of patients per year experience infiltrations that lead to an extra 97 days of catheter use and a mean of 2.4 diagnostic tests, surgeries, or interventions

Many fistulas are difficult to cannulate, and result in “blind” sticks. Look, listen, and feel techniques are often inadequate when the fistula is deep, tortuous, or small.

Deep fistulas are difficult to see through the skin; technicians must rely on only listening and feeling to find a cannulation position

Lower flow fistulas are harder to find using the listen and feel techniques, due to non-obvious bruit and thrill

Small and tortuous fistulas have less space to accommodate a needle and may be more likely to be infiltrated

 

Benefits of Ultrasound for Cannulation

  • Ultrasound technology offers many benefits in reducing catheter time, infection rates, number of failed cannulation attempts and associated costs3,4
  • One study found that ultrasound guided cannulation has been demonstrated to reduce catheter time by >30% (50 days) and infections by 37%3
  • The use of an ultrasound-guided technique facilitates easier cannulation for patients with difficult to cannulate venous fistulas

Limitations of Current Ultrasound

  • Conventional ultrasound is time consuming to master and operate
  • It is challenging for technicians to recreate the path of the fistula (a 3D object) with 2D slices
  • Conventional ultrasound requires substantial training
  • Proper probe positioning requires substantial ultrasound experience

“ People new to the use of [conventional ultrasound] should be aware that it takes daily use of ultrasound at the patient’s bedside to acquire these competencies and that around 500 ultrasound-guided needlings are required to reach the maximum competence.5 ”

EchoMap makes ultrasound accessible to everyone.

Sonavex’s EchoMap technology is designed to provide the benefits of ultrasound-guided cannulation without the need for extensive training.

EchoMap is designed to provide technicians with helpful images showing fistula trajectory and depth. Together, these images provide the cannulator a complete picture of the fistula without requiring ultrasound knowledge, dexterity, or image interpretation.

Clinician in blue gloves inserting needle into a patient’s upper arm while an adjacent touchscreen imaging device displays a color vascular scan.

REFERENCES:

  1. Van Loon MM, Kessels AGH, Van Der Sande FM, Tordoir JHM. Cannulation and vascular access-related complications in hemodialysis: Factors determining successful cannulation. Hemodial Int. 2009;13(4):498-504. doi:10.1111/j.1542- 4758.2009.00382.x
  2. Lee T, Barker J, Allon M. Needle Infiltration of Arteriovenous Fistulae in Hemodialysis: Risk Factors and Consequences. Am J Kidney Dis. 2006;47(6):1020-1026. doi:10.1053/j. ajkd.2006.02.181
  3. Coritsidis GN, Machado ON, Levi-Haim F, Yaphe S, Patel RA, Depa J. Pointof-care ultrasound for assessing arteriovenous fistula maturity in outpatient hemodialysis. The Journal of Vascular Access. 2020;21(6):923-930. doi:10.1177/1129729820913437
  4. Ellingson KD, Palekar RS, Lucero CA, et al. Vascular access hemorrhages contribute to deaths among hemodialysis patients. Kidney Int. 2012;82(6):686-692. doi:10.1038/ ki.2012.185
  5. Iglesias, Ruben et al. Ultrasound guided cannulation of dialysis access. Journal of Vascular Access 2021: 22(15) 106-112.)