Kumbar Lalathaksha, Soi Vivek, Adams Elizabeth, Brown Deacon Cheryl, Zidan Mohamed, Yee Jerry
Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan, USA.
Hemodial Int. 2018 Jan;22(1):23-30. doi: 10.1111/hdi.12535. Epub 2017 Jan 9.
Infiltrations from cannulation result in significant morbidity including loss of hemodialysis (HD) vascular access (VA). Cannulation is dependent on personnel skill and VA characteristics. Surface marking of VA lacks real-time information and traditional ultrasound (US) devices are large, expensive, requiring skilled operators. Sonic Window© (Analogic Ultrasound, Peabody, MA, USA) is a coronal mode ultrasound device (CMUD) approved for VA cannulation.
Single center randomized, prospective pilot study comparing handheld US-guided cannulation of new arteriovenous fistula (AVF) to standard cannulation practices. Patients with end stage renal disease (ESRD) on in-center HD who had a new AVF cleared for cannulation and dialysis were enrolled. Patients with new AVF received either standard cannulation (control group) or image guidance using CMUD (study group) for 3 weeks. Ultrasound characteristics of VA, cannulation practices and complications end points were obtained.
An infiltration rate of 9.7% was noted during the study. Slightly lower odds ratio (OR) of infiltration was observed in the study group (OR 0.94, 95% CI: 0.26-3.41, P value = 0.93). Study group yielded longer time for assessment (101.8 ± 80.2 vs. 22.3 ± 22.5 seconds, P = < 0.001), increased cannulation time (41.1 ± 70.6 vs. 25.0 ± 27.9 seconds, P = 0.04), and increased patient satisfaction (94.6% vs. 82%, P = 0.04) compared to control group. Number of cannulation attempts, needle size, arterial or venous needle insertion, and tourniquet usage between groups were not statistically different.
Handheld ultrasound is a safe and useful aid in cannulation of dialysis access.
插管导致的渗漏会引发严重的并发症，包括血液透析（HD）血管通路（VA）丧失。插管依赖于操作人员的技能和VA的特征。VA的体表标记缺乏实时信息，而传统的超声（US）设备体积大、价格昂贵，且需要熟练的操作人员。Sonic Window©（美国马萨诸塞州皮博迪市Analogic超声公司）是一种经批准用于VA插管的冠状模式超声设备（CMUD）。
单中心随机前瞻性试点研究，比较手持超声引导下新动静脉内瘘（AVF）插管与标准插管操作。纳入在中心进行HD的终末期肾病（ESRD）患者，这些患者有新的AVF且已获批进行插管和透析。有新AVF的患者接受标准插管（对照组）或使用CMUD进行图像引导（研究组），为期3周。获取VA的超声特征、插管操作和并发症终点。
研究期间观察到渗漏率为9.7%。研究组的渗漏优势比（OR）略低（OR 0.94，95%CI：0.26 - 3.41，P值 = 0.93）。与对照组相比，研究组的评估时间更长（101.8 ± 80.2秒对22.3 ± 22.5秒，P < 0.001），插管时间增加（41.1 ± 70.6秒对25.0 ± 27.9秒，P = 0.04），患者满意度提高（94.6%对82%，P = 0.04）。两组之间的插管尝试次数、针头尺寸、动脉或静脉针头插入以及止血带使用情况无统计学差异。
手持超声在透析通路插管中是一种安全且有用的辅助工具。
